Chuang Min-Chun, Chang Chih-Hao, Lee Chung Shu, Li Shih-Hong, Hsiao Ching-Chung, Fang Yueh-Fu, Hsieh Meng-Jer
Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, No. 6, Sec. West, Chia-Pu Road, Pu-Tz City, Chiayi, 613, Taiwan.
Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan.
BMC Pharmacol Toxicol. 2018 Nov 13;19(1):72. doi: 10.1186/s40360-018-0263-9.
Acute cholinesterase inhibitor (CI) poisoning, including organophosphate and carbamate poisoning, is a crucial problem in developing countries. Acute intoxication results in a cholinergic crisis, neurological symptoms, or respiratory failure. However, the short-term and long-term outcomes of CI poisoning are seldom reported.
Data from the National Health Insurance Research Database were used to investigate the outcomes after organophosphate and carbamate poisoning. Patients who were hospitalized for a first episode of acute CI poisoning between 2003 and 2012 were enrolled in this study. Outcomes of acute CI poisoning with or without mechanical ventilation were analyzed.
Among 6832 patients with CI poisoning, 2010 developed respiratory failure requiring mechanical ventilation, and the other 4822 patients did not require mechanical ventilation. The hospital mortality rate was higher in patients requiring mechanical ventilation than in those not requiring mechanical ventilation (33.3% versus 4.7%, p < 0.0001). In patients with respiratory failure with mechanical ventilation, the patients without pneumonia had higher mortality rate than those with pneumonia. (36.0% versus 19.9%, p < 0.0001). The 1-year mortality rate the survivors of CI poisoning was 6.7%. Among 5932 survivors after cholinesterase inhibitor poisoning, the one-year mortality rate in patients with mechanical ventilation during hospitalization was higher than those without mechanical ventilation during hospitalization (11.4% versus 5.4% respectively, p < 0.0001).
The one-year mortality rate of survivors after CI poisoning was 6.7%. Meanwhile, age, pneumonia, and mechanical ventilation may be predictive factors for the one-year mortality among the survivors after CI poisoning. Diabetes mellitus was not a risk factor for hospital mortality in patients with CI poisoning.
急性胆碱酯酶抑制剂（CI）中毒，包括有机磷和氨基甲酸酯中毒，是发展中国家的一个关键问题。急性中毒会导致胆碱能危象、神经症状或呼吸衰竭。然而，CI中毒的短期和长期后果鲜有报道。
利用国民健康保险研究数据库的数据调查有机磷和氨基甲酸酯中毒后的结局。纳入2003年至2012年间因首次急性CI中毒住院的患者。分析了有无机械通气的急性CI中毒结局。
在6832例CI中毒患者中，2010例发生呼吸衰竭需要机械通气，另外4822例患者不需要机械通气。需要机械通气的患者的医院死亡率高于不需要机械通气的患者（33.3%对4.7%，p<0.0001）。在机械通气的呼吸衰竭患者中，无肺炎患者的死亡率高于有肺炎患者（36.0%对19.9%，p<0.0001）。CI中毒幸存者的1年死亡率为6.7%。在胆碱酯酶抑制剂中毒后的5932例幸存者中，住院期间接受机械通气的患者的1年死亡率高于未接受机械通气的患者（分别为11.4%对5.4%，p<0.0001）。
CI中毒幸存者的1年死亡率为6.7%。同时，年龄、肺炎和机械通气可能是CI中毒幸存者1年死亡率的预测因素。糖尿病不是CI中毒患者医院死亡的危险因素。
