Pharmacology, Toxicology, and Therapeutics Unit, Centre for Cardiovascular Science, and Centre for Pesticide Suicide Prevention, University of Edinburgh, Edinburgh EH16 4TJ, United Kingdom; email:
Annu Rev Pharmacol Toxicol. 2019 Jan 6;59:341-360. doi: 10.1146/annurev-pharmtox-010818-021842. Epub 2018 Sep 19.
Organophosphorus insecticide self-poisoning is a major global health problem, killing over 100,000 people annually. It is a complex multi-organ condition, involving the inhibition of cholinesterases, and perhaps other enzymes, and the effects of large doses of ingested solvents. Variability between organophosphorus insecticides-in lipophilicity, speed of activation, speed and potency of acetylcholinesterase inhibition, and in the chemical groups attached to the phosphorus-results in variable speed of poisoning onset, severity, clinical toxidrome, and case fatality. Current treatment is modestly effective, aiming only to reactivate acetylcholinesterase and counter the effects of excess acetylcholine at muscarinic receptors. Rapid titration of atropine during resuscitation is lifesaving and can be performed in the absence of oxygen. The role of oximes in therapy remains unclear. Novel antidotes have been tested in small trials, but the great variability in poisoning makes interpretation of such trials difficult. More effort is required to test treatments in adequately powered studies.
有机磷杀虫剂中毒是一个全球性的主要卫生问题，每年导致超过 10 万人死亡。它是一种复杂的多器官疾病，涉及到胆碱酯酶的抑制，以及可能其他酶的抑制，以及摄入的大量溶剂的影响。有机磷杀虫剂之间的变异性-在脂溶性、激活速度、乙酰胆碱酯酶抑制的速度和效力，以及与磷相连的化学基团-导致中毒发作速度、严重程度、临床中毒症状和病死率的不同。目前的治疗方法效果有限，仅旨在重新激活乙酰胆碱酯酶并对抗毒蕈碱受体上过量乙酰胆碱的作用。在复苏过程中快速滴定阿托品是救命的，并且可以在没有氧气的情况下进行。肟类化合物在治疗中的作用仍不清楚。新型解毒剂已在小型试验中进行了测试，但中毒的巨大变异性使得此类试验的解释变得困难。需要更多的努力来进行足够强大的研究测试治疗方法。
