Benslama A, Moutaouakkil S, Mjahed K, el Moknia M, Lahbil D, Fadel H
Service de Réanimation médicale, CHU Ibn Rochd, Casablanca, Maroc.
Presse Med. 1998 Apr 18;27(15):713-5.
Acute poisoning by an organophosphorus insecticide is frequently observed in Morocco. We report a case of malathion poisoning complicated by an intermediate syndrome.
A 42-year-old woman was hospitalized 3 hours after ingestion of 50 g of malathion. Intubation and ventilatory assistance was required due to failing consciousness and bronchial plugging. On day 4, a neurological syndrome suggestive of the intermediary syndrome with diaphragmatic palsy made it necessary to continue ventilatory assistance to day 20.
The intermediary syndrome occurs 24 to 96 hours after the acute cholinergic phase of organophosphorus poisoning. It consists of an exclusive neuromuscular involvement. The intermediate syndrome is confined to an abnormality of neuromuscular function in specific muscle groups: proximal limb muscles, neck flexors, motor cranial nerves and respiratory muscles, with difficult weaning from respiratory assistance. The intermediary syndrome is quite uncommon. The risk of respiratory failure emphasizes the need for close monitoring in an intensive care setting for at least 96 hours, depending on the intensity of the cholinergic syndrome.
在摩洛哥，有机磷杀虫剂急性中毒情况屡见不鲜。我们报告一例马拉硫磷中毒并发中间综合征的病例。
一名42岁女性在摄入50克马拉硫磷3小时后入院。因意识不清和支气管堵塞，需要进行插管和通气辅助。第4天，出现提示中间综合征伴膈肌麻痹的神经综合征，使得通气辅助不得不持续到第20天。
中间综合征发生在有机磷中毒急性胆碱能期后的24至96小时。它仅累及神经肌肉。中间综合征局限于特定肌肉群的神经肌肉功能异常：近端肢体肌肉、颈部屈肌、运动性颅神经和呼吸肌，导致呼吸辅助撤机困难。中间综合征相当罕见。呼吸衰竭风险强调，根据胆碱能综合征的严重程度，在重症监护环境中至少密切监测96小时的必要性。
