Peduto V A, D'Uva R, Piga M
Istituto di Anestesiologia e Rianimazione, Università degli Studi, Cagliari.
Minerva Anestesiol. 1996 Jan-Feb;62(1-2):33-54.
Carbamate and organophosphate poisoning is a well known toxicological problem in developing countries, but still has, even in industrialized ones, a high mortality rate and a frequent invalidating outcome. Serious problems especially arise from cardiac (toxic myocarditis, QT prolongation, and other ventricular arrhythmias), muscular (intermediate syndrome, OPIDN), and neuro-behavioral (regressive psychosis, cognitive, mnesic and perceptive alterations) sequelae. Such complications, caused by direct neuronal, cardiac, and muscular damage, sneaky appear immediately after resolution of cholinergic crisis. Early establishment of antidotal (atropine + oximes) and supportive therapy, while reducing duration and seriousness of cholinergic crisis, should increase survival rates. In order to improve "quoad valetudinem" prognosis, widespread use of benzodiazepines is still recommended: such drugs antagonize some central signs and symptoms of cholinergic attack insensitive to atropine (fasciculations, muscular spasms, seizures, anxiety, psychomotor agitation). Moreover, they attenuate neuronal, cardiac, and muscular damage, caused by cholinergic overstimulation, which is responsible for invalidating outcome.
氨基甲酸酯类和有机磷酸酯类中毒在发展中国家是一个众所周知的毒理学问题，即便在工业化国家，其死亡率依然很高，致残后果也很常见。严重问题尤其源于心脏方面（中毒性心肌炎、QT间期延长及其他室性心律失常）、肌肉方面（中间综合征、有机磷中毒迟发性神经病）以及神经行为方面（退行性精神病、认知、记忆和感知改变）的后遗症。这些由直接的神经元、心脏和肌肉损伤引起的并发症，会在胆碱能危象消退后悄然出现。尽早开展解毒治疗（阿托品+肟类药物）和支持性治疗，在缩短胆碱能危象的持续时间并减轻其严重程度的同时，应能提高生存率。为改善“健康状况”预后，仍建议广泛使用苯二氮䓬类药物：这类药物可对抗一些对阿托品不敏感的胆碱能攻击的中枢体征和症状（肌束震颤、肌肉痉挛、癫痫发作、焦虑、精神运动性激越）。此外，它们可减轻由胆碱能过度刺激导致的神经元、心脏和肌肉损伤，而这种损伤是导致致残后果的原因。
