| Background Organophosphate compounds are commonly used in agriculture (pesticides) and in chemical warfare (nerve agents), and organophosphate pesticides (OP) are the most widely used insecticides available today. Because of widespread use and easy accessibility, OP results in a huge number of intoxications and several hundred thousands of fatalities annually. Acute organophosphate poisoning (AOPP) has been a major public health concern all over the world. It is a leading cause of high morbidity and mortality, especially in many developing countries. The mechanism for the toxicity of organophosphate is mainly by inhibiting of acetylcholinesterase (AChE).The net result is the accumulation of excess acetylcholine (ACh) at the cholinergic nerve endings all over the body resulting in the characteristic clinical manifestations. Following acute exposure, organophosphate can lead to three well defined neurological syndromes i.e. acute cholinergic crisis, intermediate syndrome and delayed neurotoxicity. The studies have found other delayed damages irrelevant to inhibition of AchE. So, we designed this polycentric study and case follow up survey.Objective To study the incidence of delayed damage and its related factors after acute organophosphorus pesticides poisoning(AOPP).Methods The patients with AOPP were selected throughout their admission to 4 county hospitals in shandong province where the incidence of organophosphorus pesticide poisoning is high. And all cases of AOPP in the observation period were chosen to follow up 2 months later after systemic treatment. They were interviewed with questionnaires face to face by the persons trained. The content of investigation includes patient's gender, age, education level and poisoning history, organophosphorus pesticide use levels and physical examination (including the symptom of psychic, central nervous system and peripheral nervous system) and so on.Results (1)The case fatality rate was 3.64%(11/302). There were 269 complete data and 257 patients were selected and interviewed by questionnaires. The mean age of 257 cases was 32.94, and oral poisoning was the main cause of reason of AOPP. (2)The incidence rate of IMS was 8.61% (26/302) and 19.55%(26/133) in severe cases. IMS might occur 1～7 days after the organophosphorus pesticides poisoning, and cases needed the emergent artificial respiration and recovered autonomic respiration in 10-23 days. The occurrence of IMS was related to the degree of poisoning and kinds of organophosphorus pesticides (OPS) , but relation of occurrence of IMS and the use of pralidoxime was not obvious. (3)Nine cases of organophosphate induced delayed polyneuropathy (OPIDP) were found and the incidence rate was 3.50%. Most of the OPIDP cases recovered slowly. The occurrence(s) of OPIDP were related to IMS or not and the degree of poisoning, and the kinds of organophosphorus pesticides (OPS). (4)The frequency of headache, insomnia ,amnesia, general tiredness, hyperhidrosis, was statistically higher than that before acute poisoning (P<0.05). The positive rate of symptoms of peripheral nerves, central nerves and psychogeny except auditory and visual hallucination after poisoning was significantly higher than that before (P<0.05). The patient's situation of health, the psychology situation ,economy and work became statistically worse (P<0.05). The life ability of patients was obviously weakened. There was not obvious change in neighborhood and family relationship after poisoning.Conclusion We found some delayed effects on neuropsychopathy after AOPP which could affect the patients life quality. The control measure should be administered as early as possible. No other organic pathologic changes were found in this follow-up study. |
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