Good J L, Khurana R K, Mayer R F, Cintra W M, Albuquerque E X
University of Maryland School of Medicine, Department of Neurology, Baltimore 21201.
J Neurol Neurosurg Psychiatry. 1993 Mar;56(3):290-4. doi: 10.1136/jnnp.56.3.290.
A 51 year old man developed progressive cranial and proximal muscle weakness, hyperreflexia and mental change. The disorder progressed over 9 days following the fifth weekly spraying with the organophosphate (OP) insecticide, phosmet, with limited symptoms of acute toxicity. Marked decremental responses of 50-80% on slow and fast rates of stimulation were improved to 15% by edrophonium or neostigmine. Intracellular recordings at the endplate region of intercostal muscle revealed small miniature endplate potentials (mepps), reduced mean acetylcholine sensitivity and normal membrane potentials. Electronmicroscopy revealed degeneration and regeneration of the endplates. This study demonstrates that OP poisoning due to phosmet can produce a subacute postsynaptic neuromuscular syndrome without marked symptoms of acute toxicity.
一名51岁男性出现进行性颅部及近端肌肉无力、反射亢进和精神改变。在每周第五次喷洒有机磷酸酯（OP）杀虫剂亚胺硫磷后，病情在9天内进展，急性毒性症状有限。慢频率和快频率刺激时出现50% - 80%的明显递减反应，经依酚氯铵或新斯的明治疗后改善至15%。肋间肌终板区域的细胞内记录显示微小终板电位（mepps）变小、平均乙酰胆碱敏感性降低以及膜电位正常。电子显微镜检查显示终板退变和再生。本研究表明，亚胺硫磷所致的OP中毒可产生亚急性突触后神经肌肉综合征，而无明显急性毒性症状。
