内科学教学课件：急性有机磷杀虫药中毒VIP

1、Acute organic phosphorus insecticides poisoning 急性有机磷杀虫药中毒,Overview,OPI belong to organophosphate/有机磷酸酯or dithio phosphate ester/硫代磷酸酯类compounds,most is oily or crystal.Color from light yellow to brown. Slightly volatile, and the smell of garlic . OPI on human and animal toxicity is mainly of acetyl

2、choline enzyme/乙酰胆碱酯酶inhibition ,cause the accumulation of acetylcholine/乙酰胆碱.,rank poison /剧毒类：LD5010mg/kg phorate, phosphorus absorption and parathion /甲拌磷、内吸磷、对硫磷 high poison /高毒类：LD50 10100mg/kg methyl parathion, methamidophos, dichlorvos/甲基对硫磷、甲胺磷、敌敌畏 moderate poison /中毒类：LD50 1001000mg/kg dime

3、thoate, trichlorfon/乐果、敌百虫 low poison /低毒类：LD50 10005000mg/kg mara sulphur phosphorous /马拉硫磷,Category,Etiology Occupational poisoning Production, using Living poisoning,Etiology severe person convulsions or coma. Serious breathing, circulation central inhibition and death /轻者头晕，头痛，情绪不稳；重者抽搐昏迷， 严重者呼吸

4、、循环 中枢抑制而死亡。,Clinical manifestation,4.Local lesion sensitization dermatitis/过敏性皮炎，exfoliative dermatitis/剥脱性皮炎,（二）Delayed polyneuropathy/迟发性多发神经病： Poisoning symptoms disappeared in 2 3 weeks after feeling, sports multiple neuropathy ,mainly involving the extremities, Can have lower limb paralysis, l

5、imb muscle atrophy,etc. 中毒症状消失后23周出现的感觉、运动型多发性神经病变，主要累及肢体末端、可有下肢瘫痪、四肢肌肉萎缩等。 mechanism:organophosphorus pesticide inhibit nerve target esterase and aging /有机磷杀虫剂抑制神经靶酯酶并使其老化。,Clinical manifestation,（三）Intermediate syndrome/中间型综合征 Occur within 24-96 h after poisoning,between the cholinergic crisis and

6、 late-onset neuropathy / 发生于中毒后24-96h，在胆碱能危象和迟发性神经病之间。,Clinical manifestation,Main show is muscle weakness, involving the cervical muscle, proximal limb muscles, cranial nerve ， and muscle weakness, may involve respiratory muscle. Performance for：look up hard, drooping eyelids, open difficult, yan f

7、acial masticatory muscle weakness, voice hoarse, difficulty swallowing and breathing myoparalysis /屈颈肌，肢体近端肌，颅神经、支配的肌肉无力，重者累及呼吸肌。表现：抬头困难，眼睑下垂，睁眼困难，咀嚼肌无力，声音嘶哑，吞咽困难，呼吸肌麻痹 Mechanism:cholinesterase affected by long-term suppression,impact the nerve - muscle postsynaptic joint function . /胆碱酯酶受到长期抑制，影响神经

8、肌肉接头处突触后功能,Determination of blood cholinesterase activity/胆碱酯酶活力测定 Normal choline enzyme activity value of 100% Mild 70-50% Moderate 50-30% Severe 30% Urinary metabolite determination of organic phosphorus,Laboratory examination,History of exposure to organophosphorus pesticides Typical clinical man

9、ifestations Laboratory test ：ChE, urinary metabolite,Diagnosis,Mild poisoning, muscarinic signs, ChE fell to 70-50% of normal /毒蕈碱样症状 Moderate poisoning, muscarinic signs +nicotine signs , ChE down to about 50-30% of normal./毒蕈碱烟碱样症状 Severe poisoning, in addition to the above signs ,have coma, pulmo

10、nary edema and cerebral edema, ChE dropped to below 30% of normal. /昏迷、肺水肿、脑水肿,Degree classification,Treatment,Cleaning the poisoning Take away from the scene Cleaning the skin， hair and nails Gastric lavage：Trichlorfon avoid alkaline drugs /敌百虫忌碱性药，Parathion avoid potassium permanganate /对硫磷忌高锰酸钾 C

11、atharsis,Emergency recovery/紧急复苏 Pneumonedema, respiratory muscle paralysis, respiratory failure ，cardiac arrest/肺水肿，呼吸肌麻痹，呼吸衰竭，心脏骤停,Antidote/解毒药 Principles：use antidotes as soon as possible, in sufficient quantities, coadunation and repeat. Cholinesterase reactivator/胆碱酯酶复活剂：Oxime compounds,remove

12、nicotine toxic effects /肟类化合物，解除烟碱样毒性作用. pralidoxime chloride, pralidoxime iodide obidoxime Chloride/氯解磷定、碘解磷定、双复磷,Cholinoceptor blocking drugs/胆碱受体拮抗药 （1）M cholinergic antagonistsatropine，anisodamine/山莨菪碱 Alleviate muscarinic symptoms and against respiratory central inhibition /缓解毒蕈碱样症状和对抗呼吸中枢抑制 Pr

13、inciples: Atropine，gradually reduced，to maintain the dosage 阿托品化、逐渐减量、维持用量,difference between atropine and atropine poisoning Atropine: pupil dilation, dry mouth, dry skin, fast heart rate increases, lung wet rale disappearing./阿托品化：瞳孔扩大、口干、皮肤干燥、心率增快、肺部湿罗音消失。 Atropine poisoning: pupils significantly

14、 expanded, consciousness, dysphoria, convulsions, coma, urinary retention. /阿托品中毒：瞳孔明显扩大、神志模糊、烦躁不安、抽搐、昏迷、尿潴留。,（2）N cholinergic antagonists -scopolamine /东莨菪碱 Effect center M and N acceptor，alleviate muscarinic symptoms Mild poisoning: cholinesterase reactivator Severe poisoning: cholinesterase reactivator+ cholinoceptor blocking drugs,acidosis/酸中毒 hypokalemia/低钾血症 arrhythmia/心律失常