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一例有机磷和氨基甲酸酯类杀虫剂中毒所致吞咽困难和构音障碍的病例报告

A Case Presentation in Management of Dysphagia and Dysarthria Caused due to Organophosphorus and Carbamate Insecticide Poisoning.

作者信息

Das Koyel, Nongrum Henry Benson, Mukherjee Ruchira, Bhattacharjee Shoubhik, Bhatia Dinesh

机构信息

Department of ENT, Nazareth Hospital, Shillong, Meghalaya India.

Department of Life Sciences, Presidency University, Kolkata, West Bengal India.

出版信息

Indian J Otolaryngol Head Neck Surg. 2024 Oct;76(5):4717-4723. doi: 10.1007/s12070-024-04794-6. Epub 2024 Jun 11.

Abstract

Organophosphorus and carbamate Insectiside is common in Asia-Pacific region consisting of 63% of the Global death. Organophosphorus and Carbamate poisoning can lead into different complications in the respiratory,digestive,neurological aspects and maybe fatal in certain cases.Besides medical management of the same,early rehabilitation is also required to manage different kinds of neurological aspects caused due to Organophosphorus and carbamate poisoning. The study was done to introspect the early intervention in swallowing and speech therapy in organophosphorus and carbamate poisoning individual,as a part of management besides medical intervention. A 19 years old female reported to the hospital with history of consuming organophos and carbamate insecticide with the intention of self harming causing cardiac arrest and as diagnosed as Flaccid Dysarthria with Oro-Pharyngeal Dysphagia when assessed with diagnostic tools respectively. Early speech and swallowing intervention was provided and introspected using MASA which showed improvement in scores during the therapeutic intervention and was statistically analysed using linear regression analysis. The result showed the improvement in MASA scores (the slope of the best fit) and proved that MASA scores improved significantly (slope = 14.3,  < 0.05) over time as the therapy sessions proceeded. The regression model was also significant ( < 0.05). The motor-speech therapeutic intervention provided improvement in the kinematics of oro-motor skills along with improvement in intelligibility of speech. This study concludes that early intervention in managing speech and swallowing abilities in Dysarthria and Dysphagia is helpful besides medical intervention in such cases.

摘要

有机磷和氨基甲酸酯类杀虫剂在亚太地区很常见,占全球死亡人数的63%。有机磷和氨基甲酸酯中毒可导致呼吸、消化、神经方面的不同并发症,在某些情况下可能致命。除了对其进行医学治疗外,还需要早期康复来处理因有机磷和氨基甲酸酯中毒引起的各种神经方面的问题。本研究旨在探讨对有机磷和氨基甲酸酯中毒患者进行吞咽和言语治疗的早期干预,作为除医学干预之外管理的一部分。一名19岁女性因摄入有机磷和氨基甲酸酯类杀虫剂意图自杀而被送往医院,导致心脏骤停,经诊断工具评估分别诊断为弛缓性构音障碍伴口咽吞咽困难。提供了早期言语和吞咽干预,并使用MASA进行评估,结果显示在治疗干预期间分数有所提高,并使用线性回归分析进行了统计分析。结果显示MASA分数有所提高(最佳拟合斜率),并证明随着治疗疗程的进行,MASA分数随时间显著提高(斜率=14.3,P<0.05)。回归模型也具有显著性(P<0.05)。运动言语治疗干预改善了口部运动技能的运动学,同时提高了言语清晰度。本研究得出结论,在构音障碍和吞咽困难病例中,除医学干预外,早期干预言语和吞咽能力管理是有帮助的。

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