Chen Kai-Xiang, Zhou Xin-Hua, Sun Cheng-Ai, Yan Pei-Xia
Department of Emergency, The Second People's Hospital of Lianyungang, Lianyungang 222006, China.
Medicine (Baltimore). 2019 Feb;98(6):e14371. doi: 10.1097/MD.0000000000014371.
This study aimed to explore the risk factors for acute myocardial injury (AMI) caused by acute organophosphorus pesticide poisoning (AOPP).The clinical data of 98 patients, who were treated in our hospital due to oral AOPP from April 2013 to April 2017, were retrospectively analyzed. These patients were divided into two groups: AMI group and control group. The incidence of AMI was analyzed. Furthermore, the dosage forms and dose of the pesticide, and the interval between pesticide taking and doctor visit were compared between these two groups. Moreover, their clinical symptoms were observed; the serum cholinesterase levels, myocardial injury, and heart failure markers were detected, and the occurrence of arrhythmia and the structure and function of the heart were investigated through continuous electrocardiographic monitoring and transthoracic echocardiography.Among these 98 AOPP patients, 51 patients were complicated with AMI, and the incidence was 52.0%. The main manifestations of these 51 patients with AMI were as follows: the serum levels of myocardial injury markers (creatine kinase-Mb [CK-Mb] and cardiac troponin I [cTnI]) and heart failure markers (N-terminal pro B-type natriuretic peptide [NT-pro BNP]) were significantly higher, when compared with the control group (P < .001), and the incidence of arrhythmia (FVPB, P = .02; RAA, P = .03; RVA, P = .02; ST-T changes, P = .01) and heart failure (P = .04) was also significantly higher when compared with the control group. With regard to dosage forms of the pesticides, the number of patients taking the pesticides with solvents containing aromatic hydrocarbons was significantly higher in the AMI group than in the control group (P = .001). And the number of patients taking over 100 mL of pesticides was also significantly higher in the AMI group than in the control group (P < .001). Significantly more patients in the AMI group had an interval of over 1 h between pesticide taking and doctor visit than in the control group (P < .001).Risk factors for AMI after AOPP may include the dose and dosage form of the pesticide, and the interval between pesticide taking and doctor visit.
本研究旨在探讨急性有机磷农药中毒（AOPP）所致急性心肌损伤（AMI）的危险因素。回顾性分析了2013年4月至2017年4月在我院接受口服AOPP治疗的98例患者的临床资料。将这些患者分为两组：AMI组和对照组。分析AMI的发生率。此外，比较两组患者农药的剂型和剂量，以及服药与就诊之间的间隔时间。此外，观察其临床症状；检测血清胆碱酯酶水平、心肌损伤及心力衰竭标志物，并通过连续心电图监测和经胸超声心动图检查心律失常的发生情况以及心脏的结构和功能。在这98例AOPP患者中，51例并发AMI，发生率为52.0%。这51例AMI患者的主要表现如下：与对照组相比，心肌损伤标志物（肌酸激酶同工酶[CK-Mb]和心肌肌钙蛋白I[cTnI]）和心力衰竭标志物（N末端B型利钠肽原[NT-pro BNP]）的血清水平显著升高（P<0.001），心律失常（室性早搏，P=0.02；房性心律失常，P=0.03；室性心律失常，P=0.02；ST-T改变，P=0.01）和心力衰竭（P=0.04）的发生率也显著高于对照组。关于农药剂型，AMI组服用含芳烃溶剂农药的患者人数显著高于对照组（P=0.001）。AMI组服用超过100 mL农药的患者人数也显著高于对照组（P<0.001）。AMI组服药与就诊间隔超过1小时的患者明显多于对照组（P<0.001）。AOPP后发生AMI的危险因素可能包括农药的剂量和剂型，以及服药与就诊之间的间隔时间。
