Cunha J, Póvoa P, Mourão L, Santos A L, Luís A S
Unidade de Cuidados Intensivos Médicos (UCIM), Hospital de São Francisco de Xavier, Lisboa.
Acta Med Port. 1995 Sep;8(9):469-75.
Ingestion of organophosphate (OP) compounds usually results in severe poisoning. We undertook a retrospective study of 52 consecutive patients admitted with severe OP poisoning to determine the value of serum cholinesterase (SChE) in monitoring clinical course. Considering survivors and non-survivors, we evaluate clinical and laboratory baseline characteristics, severity scores (APACHE II, SAPS II), atropine rate (mg/h), SChE evolution at 24, 72 and 120 h and final SChE (SChE at the day of discharge or death). Mortality in the ICU was 28.9% (n = 15). In both groups SChE showed a trend to increase. In survivors, SChE recovery was statistically significant for SChE 24h-SChE 72 h, SChE 24 h-SChE 120 h and SChE initial-SChE 120 h (p = 0.008, p = 0.00003, p = 0.0002 respectively). In this group a simultaneous decrease in atropine requirements was registered. In non-survivors, the rate of atropine remained unchanged up to 120 h. Three groups could be defined in non-survivors according to their final SChE and day of death. Non-survivors-1 (death in the first 24h; 2 patients) and non-survivors-2 (death after the first 24 h; 5 patients) had a final SChE below 10% of normal SChE activity and statistically different from survivors' final SChE. Non-survivors-3 (8 patients) had a final SChE similar to the survivors and death was due to sepsis and multiple organ failure (MOF). We conclude that SChE is useful in OP poisoning diagnosis and also in monitoring clinical course. SChE recovery above 10% of normal seems to correlate with good prognosis. Sepsis and MOF were important determinants of mortality.
摄入有机磷（OP）化合物通常会导致严重中毒。我们对52例连续收治的重度OP中毒患者进行了一项回顾性研究，以确定血清胆碱酯酶（SChE）在监测临床病程中的价值。综合考虑幸存者和非幸存者，我们评估了临床和实验室基线特征、严重程度评分（APACHE II、SAPS II）、阿托品用量（mg/h）、24、72和120小时时SChE的变化情况以及最终SChE（出院或死亡当天的SChE）。重症监护病房（ICU）的死亡率为28.9%（n = 15）。两组患者的SChE均呈上升趋势。在幸存者中，SChE在24小时至72小时、24小时至120小时以及初始至120小时的恢复具有统计学意义（分别为p = 0.008、p = 0.00003、p = 0.0002）。在这组患者中，阿托品的需求量同时减少。在非幸存者中，阿托品用量在120小时内保持不变。根据最终SChE和死亡日期，非幸存者可分为三组。非幸存者-1（在最初24小时内死亡；2例患者）和非幸存者-2（在最初24小时后死亡；5例患者）的最终SChE低于正常SChE活性的10%，且与幸存者的最终SChE在统计学上存在差异。非幸存者-3（8例患者）的最终SChE与幸存者相似，死亡原因是脓毒症和多器官功能衰竭（MOF）。我们得出结论，SChE在OP中毒诊断以及监测临床病程方面均有用处。SChE恢复至正常水平的10%以上似乎与良好预后相关。脓毒症和MOF是死亡率的重要决定因素。
