Ohbe Hiroyuki, Jo Taisuke, Matsui Hiroki, Fushimi Kiyohide, Yasunaga Hideo
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan.
J Med Toxicol. 2018 Sep;14(3):237-241. doi: 10.1007/s13181-018-0669-1. Epub 2018 Jun 15.
In contrast to information on the effects of organophosphate, pesticide, or environmental exposures, data on cholinergic crisis caused by pharmaceutical cholinesterase inhibitors are sparse. The present study aimed to describe the characteristics, demographics, and mortality of patients with cholinergic crisis caused by pharmaceutical cholinesterase inhibitors using a nationwide inpatient database in Japan.
We identified patients diagnosed with cholinergic crisis as a result of taking cholinesterase inhibitor medications in the Japanese Diagnosis Procedure Combination inpatient database from July 2010 to March 2016. We examined the patients' characteristics, treatments, and mortality.
A total of 235 patients with cholinergic crisis were identified during the 69-month study period. Forty-eight patients required mechanical ventilation (20.4%), and 15 patients died (6.4%) in hospital. The median lengths of hospital stay and intensive care unit stay were 15 days (interquartile range, 6-42) and 4 days (2-8), respectively. Approximately half of all hospitalized patients required catecholamines, atropine, or mechanical ventilation, while the other half did not require any of these treatments. Patients who required catecholamines, atropine, or mechanical ventilation were more likely to die and had longer hospital stays.
Cholinergic crisis caused by pharmaceutical cholinesterase inhibitors is a rare but potentially life-threatening condition. Patients who require mechanical ventilation and catecholamines or atropine have a poorer prognosis.
与有机磷酸酯、农药或环境暴露的影响信息相比，关于药物性胆碱酯酶抑制剂引起的胆碱能危象的数据很少。本研究旨在利用日本全国住院患者数据库描述药物性胆碱酯酶抑制剂引起的胆碱能危象患者的特征、人口统计学和死亡率。
我们在2010年7月至2016年3月的日本诊断程序组合住院患者数据库中，识别出因服用胆碱酯酶抑制剂药物而被诊断为胆碱能危象的患者。我们检查了患者的特征、治疗方法和死亡率。
在69个月的研究期间，共识别出235例胆碱能危象患者。48例患者需要机械通气（20.4%），15例患者在医院死亡（6.4%）。住院时间和重症监护病房住院时间的中位数分别为15天（四分位间距，6 - 42）和4天（2 - 8）。所有住院患者中约一半需要儿茶酚胺、阿托品或机械通气，而另一半不需要这些治疗中的任何一种。需要儿茶酚胺、阿托品或机械通气的患者死亡可能性更大，住院时间更长。
药物性胆碱酯酶抑制剂引起的胆碱能危象是一种罕见但可能危及生命的疾病。需要机械通气以及儿茶酚胺或阿托品的患者预后较差。
