Singh G, Mahajan R, Whig J
Department of Medicine, Dayanand Medical College, Ludhiana, India.
J Neurol Sci. 1998 May 7;157(2):191-200. doi: 10.1016/s0022-510x(98)00058-6.
Six patients with acute organophosphate pesticide poisoning in whom electrodiagnostic studies influenced or supported specific decisions in management are described. One patient was admitted to hospital with a diagnosis of acute alcoholic intoxication. Electrodiagnostic studies revealed single stimulus induced repetitive responses and decrement-increment responses at 30 and 50 Hz repetitive nerve stimulation, findings that are indicative of a depolarization block due to inactivation of acetylcholinesterase at the motor end-plate. The patient was subsequently treated as a case of acute organophosphate poisoning. The administration of edrophonium (0.1 mg) to another patient with normal neuromuscular transmission studies unmasked the latent electrophysiological abnormalities. Three instances are described in which electrodiagnostic studies were useful in predicting whether pralidoxime administration was likely to be useful and for how long was pralidoxime therapy to be continued. Phrenic nerve conduction study in one patient with impending respiratory failure revealed an unstimulable phrenic nerve. The potential role of phrenic nerve conduction studies and neuromuscular transmission studies in influencing decisions like intubation and mechanical ventilation is discussed.
本文描述了6例急性有机磷农药中毒患者，其电诊断研究对治疗管理中的特定决策产生了影响或提供了支持。1例患者因急性酒精中毒入院。电诊断研究显示，在30Hz和50Hz重复神经刺激时，单次刺激可诱发重复反应和递减-递增反应，这些发现表明运动终板处乙酰胆碱酯酶失活导致去极化阻滞。该患者随后被作为急性有机磷中毒病例进行治疗。对另1例神经肌肉传导研究正常的患者给予依酚氯铵（0.1mg）后，隐匿的电生理异常得以显现。文中描述了3例电诊断研究有助于预测解磷定给药是否可能有效以及解磷定治疗应持续多长时间的情况。1例即将发生呼吸衰竭的患者进行膈神经传导研究时发现膈神经无法被刺激。文中还讨论了膈神经传导研究和神经肌肉传导研究在影响诸如插管和机械通气等决策方面的潜在作用。
