Besser R, Weilemann L S, Gutmann L
Department of Neurology, University of Mainz Hospital, Germany.
Muscle Nerve. 1995 Jan;18(1):15-22. doi: 10.1002/mus.880180104.
Six patients with organophosphorus compound intoxications developed an intermediate syndrome (weakness and fasciculations) and obidoxime was given on eight occasions. The efficacy of the acetylcholinesterase (AChE) reactivator was monitored electrophysiologically by neuromuscular transmission studies using single and repetitive nerve stimulation (20 and 50 Hz) and the activity of the serum (butyryl) cholinesterase (ChE). Dramatic electrophysiologic improvement was seen when obidoxime was given early within 12 h in 3 patients, although evidence of AChE inhibition did not subside completely. When administration of obidoxime was delayed 26 h or more after intoxication on five occasions, electrophysiologic improvement was mild or absent. In one case, 66 h after intoxication with oxydemeton-S-methyl, the neuromuscular block worsened, indicating that aging of the AChE had been completed. The electrophysiologic improvement was always accompanied with better motor function but not necessarily with improvement of the overall clinical status. Serum ChE did not predict the oxime effect at the motor endplate. In humans, the efficacy of oximes in AChE reactivation can be determined rapidly using electrophysiologic studies.
6例有机磷化合物中毒患者出现中间综合征（肌无力和肌束震颤），共8次给予双复磷治疗。通过单刺激和重复神经刺激（20Hz和50Hz）进行神经肌肉传递研究，并检测血清（丁酰）胆碱酯酶（ChE）活性，以电生理方式监测乙酰胆碱酯酶（AChE）复活剂的疗效。3例患者在中毒后12小时内早期给予双复磷时，电生理有显著改善，尽管AChE抑制的证据并未完全消退。5次中毒后双复磷给药延迟26小时或更长时间时，电生理改善轻微或无改善。1例中毒后66小时给予氧乐果，神经肌肉阻滞加重，表明AChE老化已经完成。电生理改善总是伴随着运动功能的改善，但不一定伴随着整体临床状况的改善。血清ChE不能预测运动终板处肟类药物的效果。在人类中，使用电生理研究可快速确定肟类药物对AChE复活的疗效。
