急診急性有機磷農藥中毒的循證治療_《中國循證醫學雜志》

作者：

周榮樂 ,  吳紅梅

四川大學華西醫院老年病科（成都 610041）;

關鍵詞：

急性有機磷農藥中毒肟類膽堿酯酶復能劑阿托品

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導出 下載 收藏 掃碼 引用

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目的　應用循證醫學的基本原理和方法為急性有機磷農藥中毒患者制定合理的治療方案。
方法　針對急性有機磷農藥中毒具體病例提出臨床問題，以有機磷農藥、中毒、膽堿酯酶復能劑肟類、中間綜合征等MeSH主題詞及自由詞為關鍵詞，電子檢索ACP Journal Club（1991~2006.4）、Cochrane 圖書館（2006年第1期）、MEDLINE（1966~2006.5）和中國生物醫學文獻數據庫（1980~2006.5），查找與肟類復能劑治療急性有機磷農藥中毒有關的系統評價、臨床隨機對照試驗等，并對所獲證據進行質量評價。
結果　檢索到2005年的Cochrane系統評價和2006年Meta分析各1篇，其結果均提示，肟類復能劑對急性有機磷農藥中毒的治療效果不肯定。據此臨床證據，結合醫生經驗及患者家屬意見，對該患者未使用肟類復能劑，而是小劑量阿托品遞減劑量及對癥支持治療。一周后，患者生命體征平穩，臨床癥狀緩解出院。
結論　采用循證醫學的方法為急性有機磷中毒患者選擇了合理的治療方案。肟類復能劑對急性有機磷農藥中毒的療效不肯定，尚待大樣本高質量的隨機對照試驗證實。

引用本文： 周榮樂,吳紅梅. 急診急性有機磷農藥中毒的循證治療. 中國循證醫學雜志, 2006, 06(11): 839-842. doi: 復制

1.	秦桂璽.中毒. 見: 葉任高, 等. 主編. 內科學. 第6版. 北京: 人民衛生出版社; 2004. 948~991.
2.	Eyer P. The role of oximes in the management of organophosphorus pesticide poisoning. Toxicol Rev, 2003; 22(3): 165–190.
3.	Eddleston M. Patterns and problems of deliberate self-poisoning in the developing world. QJM, 2000; 93(11): 715–731.
4.	Qin GX. Poisoning. In: Ye RG, et al. Editor-in-chief. Internal Medicine. 6th ed. Beijing: People’s Medical Publishing House; 2004. 948–991.
5.	Guyatt GH, R ennie D, Editors. The Evidence-Based Medicine Working Group. Users’ Guides to the Medical L iterature: A Mannual for Evidence-Based Clinical Practice. Chicago: AMA Press; 2002.
6.	Phillips B, Ball C, Sackett D, et al. Levels of evidence and grades of recommendation. Available for URL: http://www.cebm.net.
7.	Buckley NA, Eddleston M, Szinicz L. Oximes for acute organophosphate pesticide poisoning. The Cochrane Database of Systematic Reviews, 2005, Issue 1.
8.	John P, John M, Petra G. Oxime therapy and outcomes in human organophosphate poisoning: An evaluation using meta-analytic techniques. Crit Care Med, 2006; 34(2): 502–510.
9.	Johnson S, Peter JV, Thomas K, et al. Evaluation of two treatment regimens of pralidoxime (1 gm single bolus vs 12 gm infusion) in the management of organophosphorus poisoning. A randomized, double blind controlled clinical trial. J Assoc Physicians India, 1996; 44(8): 529–531.
10.	Cherian AM, Peter JV, Samuel J, et al. Effectiveness of P2AM (PAM–Pralidoxime) in the treatment of organophosphate poisoning (OPP). A randomized, double blind placebo controlled clinical trial. J Assoc Physicians India, 1997; 45: 22–24.
11.	Cherian MA, Roshini C, Visalakshi J, et al. Biochemical and clinical profile after organophosphate poisoning-A placebo-controlled trial using pralidoxime. J Assoc Physicians India, 2005; 53: 427–431.
12.	de Silva HJ, Wijewickrema R, Senanayake N. Does pralidoxime affect outcome of management in acute organophosphorus poisoning? Lancet, 1992; 339(8802): 1136–1138.
13.	Balali-Mood M, Shariat M.Treatment of organophosphate poisoning. Experience of nerve agents and acute pesticide poisoning on the effect of oximes. J Physiol Paris, 1998; 92(5-6): 375–378.
14.	Abdollahi M, Jafari A, Jalali N, et al. A new approach to the efficacy of oximes in the management of acute organophosphorus poisoning. Ir J Med Sci, 1995; 20: 105–109.
15.	Sungur M, Guven M. Intensive care management of organophosphate insecticide poisoning. Crit Care (London), 2001; 5(4): 211–215.15 Medicis JJ, Stork CM, Howland MA, et al. Pharmacokinetics following a loading plus a continuous infusion of pralidoxime compared with the traditional short infusion regimen in human volunteers. J Toxicol Clin Toxicol, 1996; 34(3): 289–295.
16.	Xue SZ, Ding XJ, Ding Y. Clinical observation and comparison of the effectiveness of several oxime cholinesterase reactivators. Scan J Work Environ Health, 1985; 11(Suppl 4): 46–48.
17.	Taylor P. Anticholinesterase agents. In: Gilman AG, Goodman LS, Rall TW, et al. The Pharmacological Basis of Therapeutics. New York, Macmillan;1985. 122.

1. 秦桂璽.中毒. 見: 葉任高, 等. 主編. 內科學. 第6版. 北京: 人民衛生出版社; 2004. 948~991.
2. Eyer P. The role of oximes in the management of organophosphorus pesticide poisoning. Toxicol Rev, 2003; 22(3): 165–190.
3. Eddleston M. Patterns and problems of deliberate self-poisoning in the developing world. QJM, 2000; 93(11): 715–731.
4. Qin GX. Poisoning. In: Ye RG, et al. Editor-in-chief. Internal Medicine. 6th ed. Beijing: People’s Medical Publishing House; 2004. 948–991.
5. Guyatt GH, R ennie D, Editors. The Evidence-Based Medicine Working Group. Users’ Guides to the Medical L iterature: A Mannual for Evidence-Based Clinical Practice. Chicago: AMA Press; 2002.
6. Phillips B, Ball C, Sackett D, et al. Levels of evidence and grades of recommendation. Available for URL: http://www.cebm.net.
7. Buckley NA, Eddleston M, Szinicz L. Oximes for acute organophosphate pesticide poisoning. The Cochrane Database of Systematic Reviews, 2005, Issue 1.
8. John P, John M, Petra G. Oxime therapy and outcomes in human organophosphate poisoning: An evaluation using meta-analytic techniques. Crit Care Med, 2006; 34(2): 502–510.
9. Johnson S, Peter JV, Thomas K, et al. Evaluation of two treatment regimens of pralidoxime (1 gm single bolus vs 12 gm infusion) in the management of organophosphorus poisoning. A randomized, double blind controlled clinical trial. J Assoc Physicians India, 1996; 44(8): 529–531.
10. Cherian AM, Peter JV, Samuel J, et al. Effectiveness of P2AM (PAM–Pralidoxime) in the treatment of organophosphate poisoning (OPP). A randomized, double blind placebo controlled clinical trial. J Assoc Physicians India, 1997; 45: 22–24.
11. Cherian MA, Roshini C, Visalakshi J, et al. Biochemical and clinical profile after organophosphate poisoning-A placebo-controlled trial using pralidoxime. J Assoc Physicians India, 2005; 53: 427–431.
12. de Silva HJ, Wijewickrema R, Senanayake N. Does pralidoxime affect outcome of management in acute organophosphorus poisoning? Lancet, 1992; 339(8802): 1136–1138.
13. Balali-Mood M, Shariat M.Treatment of organophosphate poisoning. Experience of nerve agents and acute pesticide poisoning on the effect of oximes. J Physiol Paris, 1998; 92(5-6): 375–378.
14. Abdollahi M, Jafari A, Jalali N, et al. A new approach to the efficacy of oximes in the management of acute organophosphorus poisoning. Ir J Med Sci, 1995; 20: 105–109.
15. Sungur M, Guven M. Intensive care management of organophosphate insecticide poisoning. Crit Care (London), 2001; 5(4): 211–215.15 Medicis JJ, Stork CM, Howland MA, et al. Pharmacokinetics following a loading plus a continuous infusion of pralidoxime compared with the traditional short infusion regimen in human volunteers. J Toxicol Clin Toxicol, 1996; 34(3): 289–295.
16. Xue SZ, Ding XJ, Ding Y. Clinical observation and comparison of the effectiveness of several oxime cholinesterase reactivators. Scan J Work Environ Health, 1985; 11(Suppl 4): 46–48.
17. Taylor P. Anticholinesterase agents. In: Gilman AG, Goodman LS, Rall TW, et al. The Pharmacological Basis of Therapeutics. New York, Macmillan;1985. 122.

《中國循證醫學雜志》

急診急性有機磷農藥中毒的循證治療

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《中國循證醫學雜志》

急診急性有機磷農藥中毒的循證治療

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