| Purpose: Acute organophosphorus pesticide poisoning (AOPP) is the world's most common pesticide poisoning, especially in developing countries, especially in rural areas. It is one of the common factors of Accidental death for the young adults. Due to the different treatment conditions, the death rate ranged from 4-30% for different countries and regions , the average death rate of China is 10%, far higher than the foreign ones.The major mechanism of Organophosphorus pesticides (OPs) poisoning is the combine of organophosphorus pesticides and acetylcholinesterase (Acetylcholinesterase, referred to as AChE),forming a phosphorylated cholinesterase, making the acetylcholinesterase losing of the capacity of hydrolysising acetylcholine, the clinical manifestations is the exciting of choline nerve and inhibition at last , muscarinic, nicotinic and central nervous system symptoms, such as an increase in glandular secretion, sweating, salivation, muscle cramps miosis, abdominal pain, incontinence, two will be strict, fibrillation of muscle bundle, pulmonary edema, coma, etc. In severe cases, respiratory muscle weakness can occur, including the paralysis of respiratory muscle or the respiratory center to breathing. The degree of cholinesterase inhibited by poisoning the extent of positive correlation, you can use whole blood cholinesterase activity (including the red blood cell acetylcholinesterase activity and serum butyrylcholinesterase activity) to represent the organic phosphorus pesticide poisoning level, diagnostic uncertainty can be detected in whole blood cholinesterase activity in order to assist diagnosis. At present, serum butyrylcholinesterase (BuChE) activity assay has been extensively conducted in the clinical significance is equivalent to whole blood cholinesterase activity. Organophosphorus pesticide poisoning .There are three ways First, absorbed through the skin contact with poison, and second, through the digestive tract absorption of oral poisoning, and the third is through the inhalation poisoning. This study compared the skin with varying degrees of oral poisoning patients treated with new therapy, serum butyrylcholinesterase (BuChE) activity in the recovery of the similarities and differences. And thus offer some guidance on the clinical effects.Method: We contact with the poisoning patients through skin with the mild, moderate and severe oral organophosphorus pesticide poisoning patients after routine treatment seeing their recoveries of serum butyrylcholinesterase (BuChE) activity, dividing into four groups. Poisoning through the skin were divided into a group of patients, according to mild, moderate or severe poisoning, oral poisoning patients were divided into three groups. We choose the organic phosphorus pesticide poisoning patients treating in emergency department of the Second Hospital of Hebei Medical University from October 2002 to December 2009 department, including 39 cases of poisoning through the skin, and 10 cases with incomplete information (methods do not meet the specifications, partial treatment late, Monitoring data are inconsistent, ahead of time and discharged from hospital) was removed。29 patients with complete data composed a group. The number of oral organophosphorus pesticide poisoning cases was more.We randomly selected 90 cases with complete data, in which 31 cases of mild poisoning, 29 cases of moderate poisoning, 30 cases of severe poisoning. All the poisoned patients (including poisoning by skin contact and oral toxicity) were 119 cases. There are several varieties of pesticide including dichlorvos, methamidophos,omethoate , phorate. Diagnostic criteria developed by the Ministry of Health "AOPP diagnostic criteria and treatment principles" for diagnosis and treatment. Group of four patients had a clear history of exposure to organophosphorus pesticides and toxic blood test confirmed the existence of organic phosphorus pesticide ingredients, whole blood cholinesterase activity and serum butyrylcholinesterase (BuChE) activity was lower than the heath, there are different degrees of muscarinic, nicotinic and central nervous system symptoms,the degree of poisoning based on clinical manifestations ,mild poisoning (appears only muscarinic symptoms), moderate poisoning (appears muscarinic and nicotinic symptoms), and severe poisoning (basing on moderate poisoning,having emergence of respiratory failure). The new therapy, methods are as follows: the principle is to terminate the contact with the poison at first, throughly wash the skin and gastric lavage, catharsis. Secondly, according to the clinical manifestations and serum butyrylcholinesterase (BuChE) activity to determine the degree of poisoning, and further decided to PAM and atropine dosage, using PAM and maintain atropinization. Adhere to a phased view of atropinization, poisoning within 24 hours of adhere to the traditional standards of atropinization (pupil dilatation, facial flushing, dry skin, dry mouth, pulmonary rales disappeared faster heart rate to 100-120 beats / min ) after 24 hours or the sufficient application of the PAM adhere to the new standards of atropinization (dry mouth, dry skin), adjust the dosage of atropine, maintenan the atropinization At the meantime we support nutrition, maintain the water and electrolyte balance, anti-infective, use mechanical ventilation when respiratory failure and tracheal intubation for mechanical ventilation happen.The specific methods of serum butyrylcholinesterase (BuChE) activity of are as follows: four groups of organophosphorus pesticide poisoning were phlebotomized 2 ml while patients in the emergency treatment respectively instantly, and also at 8 o'clock every morning on the 2nd, 3rd, 4th, 5th day in hospital. Inject the blood sample into plastic vacuum tube (made by a Japanese joint venture company). 30 minutes later, we pick up the serum by means of centrifugation. It is proposed to use ARCHITECT ci8200, an Automatic Immunity Biochemistry Analyzer made by U.S. Johnson & Johnson Company, and associated reagent made by Beijing Municipal Zhongsheng Beikong Biology Science and Technology Co.Ltd, to determine serum BuChE.The butyrylcholinesterase (BuChE) activity was seen as a factor to observe, we compare the different recoveries of butyrylcholinesterase (BuChE) activity in the course of treatment.Results: There are 26 males and 3 females in the patient of AOPP through skin, there are 16 males and 14 females in the patient of mild oral AOPP, there are 15 males and 15 females in the patient of oral moderate AOPP, there are 14 males and 15 females in the patient of oral severe AOPP, the proportion of men and women constitute were different, the result was statistically significant (P <0.01).The age structures were similar,and had no statistical significance (P> 0.05).Regardless of poisoning through the skin, or mild, moderate and severe oral poisoning, serum BuChE activity of the acute organophosphorus pesticide poisoning patient reduced ,which was statistical significance compared with the normal group (P <0.05), through the skin poisoning group and, through the The levels of serum BuChE activity of poisoning through skin recoveres slower after conventional treatment compared with the mild, moderate and severe oral intoxication group , the difference was statistically significant (P <0.05). After the new treatment, the serum BuChE activity of poisoning through the skin recoveried slowly, and the oral intoxication recoveried at more rapid speeds, (using the average recovery speed to express the recoveriy speed, poison through the skin group, the average rate of development was 1.08; oral mild, severe poisoning, the average rate of development were 1.21,1.28,1.61).Whether the acute organic phosphorus pesticide poisoning through skin contact or oral, the clinical symptoms gradually improved and the poisoning index decreased gradually after the new therapy , but the recovery of cholinesterase activity is different,the clinical prognosis is good.Conclusion:1,The AOPP patients through the skin is mostly mild or moderate poisoning, clinical symptoms are untypical, incubation period was long,the serum BuChE activity decreased significantly .2,The AOPP patients through the skin were mainly males.3,Using PAM and maintain atropinization is a safe and effective clinical treatment to accur AOPP , The clinical symptoms in each group were gradually improved with the new treatment, recovery, prognosis is good.4,Through the new therapy, the serum BuChE activity recoveries recoveries rapidly which compared with the poisoning patients through the skin. Both clinical symptoms were both improved after treatment. the levels of serum BuChE activity of oral toxicity recovered gradually, and parallelled with the clinical manifestations, it can be used as the severity of poisoning and the discharge standards.The serum butyrylcholinesterase (BuChE) activity in skin poisoning groop recovered slowly.The clinical manifestations progress after treatment.The serum BuChE activity can not be the standards of severity of poisoning and discharge standards, It should be combined with clinical judgments. |
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