The value of toxicological analysis in acute poisoning patients with uncertain exposure histories:a retrospective and descriptive study from an institute of poisoning

BACKGROUND:In clinical practice,some patients might not be able or unwilling to provide a thorough history of medication and poison exposure.The aim of this study was to use toxicological analysis to examine the clinical characteristics of patients with acute poisoning whose exposure history was uncertain from a toxicological analysis perspective.METHODS:This was a retrospective and descriptive study from an institute of poisoning.Patient registration information and test reports spanning the period from April 1,2020 to March 31,2022,were obtained.Patients with uncertain exposure histories and who underwent toxicological analysis were included.Clinical manifestations and categories of toxics were analyzed.RESULTS:Among the 195 patients with positive toxicological analysis results,the main causes of uncertain exposure history was disturbance of consciousness(62.6%),unawareness(23.6%)and unwillingness or lack of cooperation(13.8%).The predominant clinical manifestations were disturbed consciousness(62.6%),followed by vomiting and nausea(14.4%)and liver function abnormalities(8.7%).A comparison of clinical manifestations between patients with positive and negative(n=99)toxicological analyses results revealed significantly different proportions of disturbances in consciousness(63%vs.21%),dizziness(1.5%vs.5.1%),multi-organ failure(1.5%vs.7.1%),and local pain(0 vs 4%).The main categories of substances involved were psychiatric medications(23.1%),sedatives(20.5%),insecticides(13.8%),and herbicides(12.8%).CONCLUSION:The clinical manifestations of acute poisoning in patients with an uncertain exposure history are diverse and nonspecific,and toxicological analysis plays a pivotal role in the diagnosis and differential diagnosis of such patients.

Clinical Case Report of Acute Heart Injury and Acute Rhabdomyolysis Due to Cyanide Poisoning

Cyanide poisoning is one of the most dangerous poisonings, and it can be absorbed into the body through the mouth, inhalation and through the skin. A 32-year-old female patient was admitted to our poison control center because of high fever, severe vomiting, and seizures. Physical examination found that the patient was drowsy, had a high fever of 40 degrees Celsius, pulse of 140 beats/minute, and increased tendon and bone reflexes. Exploiting the patient’s information, it was discovered that the patient bought Cyanide to drink with the intention of committing suicide. The patient was quickly treated with gastric lavage and activated charcoal. Echocardiography recorded EF: 35%, reduced movement of the entire myocardium. CK blood test: 4562 U/L. The patient’s condition rapidly deteriorated and the patient was made ECMO, IHD and CVVHDF. After 3 days of treatment, the patient’s condition did not improve, so the family asked for the patient to go home. This article aims to describe the rapidly progressing and severe damage to the heart and muscles of patients with cyanide poisoning.

Paradoxical systemic toxicity by inhaled paraquat poisoning: A case report

Rationale:Multi-organ failure is a symptom of paraquat poisoning,resulting in high mortality and morbidity rates.Though paraquat is widely available,poisoning through inhalation is rare.Patient’s Concern:A 37-year-old male reported to the emergency department with complaints of vomiting after an alleged history of inhalation of paraquat while at work.Diagnosis:Paraquat poisoning.Interventions:Supportive management along with multiple sessions of hemodialysis.Outcomes:Renal complications caused by paraquat were improved after multiple sessions of hemodialysis.However,the patient developed respiratory complications and later due to persistent hypoxemia and non-responsive to supportive therapy,he succumbed to his illness.Lessons:Acute kidney injury is a complication of paraquat poisoning.However,kidney involvement with the inhalational mode is rare.It is caused by reduction and oxidation cycles,as well as the formation of reactive oxygen species,necessitating hemodialysis as the treatment.Without a clear history,a specific clinical trait,or a diagnostic test,diagnosis can be difficult.Our case thus highlights the inhaled paraquat poisoning,presenting with acute kidney injury with late respiratory impairment as a consequence.

Acute carbon monoxide poisoning and delayed neurological sequelae: a potential neuroprotection bundle therapy

Currently, there is no known optimal therapy for carbon monoxide （CO） poisoning and CO-associated delayed neu- rological sequelae. Hyperbaric oxygen therapy （HBOT） is a well-known treatment method, but its use for CO poison- ing patients is controversial to use due to lack of evidences regarding its efficacy. Thus, it is unlikely that HBOT alone will be accepted as the standard treatment method. In this article, current and potential treatment methods of CO poi- soning are presented as well as the tentative multi-factorial pathophysiology. A series of treatments are suggested for use as a bundle therapy, with targeted temperature management as the base treatment method. Such a therapy holds a great potential, especially for the cases where HBOT is not readily available. We suggest further investigations for elucidating the effects of these suggested treatments and their roles in terms of the complex pathophysiology of CO poisoning. Future ac- ceptance of this therapy based on the improved scientific and clinical knowledge may result in injury prevention and mini- mization of the signs and the symptoms in CO poisoning.

Clinical correlates of hypotension in patients with acute organophosphorus poisoning

BACKGROUND:The aim of the present study is to describe the clinical correlates of hypotension and its associated outcomes in patients with acute organophosphorus poisoning(AOPP).METHODS:In this retrospective cohort study,we analyzed data pertaining to 871 patients with AOPP who were treated at two hospitals.Data from hypotensive and non-hypotensive patients were compared to identify clinical correlates of hypotension.We also evaluated the association between clinical parameters(including hypotension)and in-hospital mortality.RESULTS:The incidence of hypotension in AOPP patients was 16.4%.Hypotensive patients showed signifi cantly higher in-hospital mortality(1.1%vs.39.9%,P<0.001).Advanced age(odds ratio[OR]1.25,95%confi dence interval[CI]1.08–1.44),history of diabetes(OR 2.65,95%CI 1.14–5.96),and increased white blood cell count(OR 1.06,95%CI 1.03–1.09),plasma cholinesterase(OR 0.91,95%CI 0.84–0.94),plasma albumin(OR 0.88,95%CI 0.85–0.92),serum amylase(OR 1.01,95%CI 1.01–1.02),and blood pH(OR 0.64,95%CI 0.54–0.75)were signifi cantly associated with hypotension.After adjusting for potential confounders,hypotension was associated with increased in-hospital mortality(hazard ratio 8.77–37.06,depending on the controlled variables).CONCLUSIONS:Hypotension is a common complication of AOPP and is associated with increased in-hospital mortality.Advanced age,history of diabetes,and changes in laboratory parameters were associated with hypotension in AOPP patients.

Acute Pesticide Poisoning in Jiangsu Province, China, from 2006 to 2015

This study aimed to investigate the characteristics of pesticide poisoning in Jiangsu Province, China, and to provide a scientific basis for developing effective interventional measures and preventive strategies. From 2006 to 2015, a total of 35,308 cases of pesticide poisoning were reported in Jiangsu Province. Non‐occupational poisoning accounted for 73.79% of all poisoning cases. A comparison of the data collected before（2006） and after（2015） this study showed a decrease in non‐occupational pesticide poisoning. Pesticide poisoning showed an age central tendency of 30 to 44 years, area central tendency for northern Jiangsu, and seasonal central tendency of occupational pesticide poisoning in autumn. Pesticide poisoning remains a major health concern in China. Government agencies together with scientists should focus their efforts on the prevention of potential threats to vulnerable groups such as the elderly, women, and children.

Acute lung injury mechanism and therapy induced by paraquat poisoning

Paraquat (PQ, methyl viologen) was widely used in agricultural production throughout the world in 1962 for its efficient herbicidal activity. PQ was also highly toxic drug. About 5 mL medicine including 20% paraquat was life-threatening that can cause poisoning. In 1966, some people died because of PQ poisoning. Most patients had acute respiratory distress syndrome after 2 wk, and 70% of them died due to the lack of effective detoxification drugs. Thus, it was particularly important to understand the pathogenesis of PQ poisoning and give some effective treatments. This article will review the toxicological mechanism and treatment on PQ poisoning of acute lung injury.

Acute methanol poisoning with bilateral diffuse cerebral hemorrhage:A case report

BACKGROUND Acute methanol poisoning(AMP)is a systemic disease that mainly affects the central nervous system and is characterized by ocular damage and metabolic acidosis.If appropriate treatments are inadequate or delayed,the mortality can exceed 40%.As the most serious complication,cerebral hemorrhage is rare with reported prevalence of 7%-19%.CASE SUMMARY A 62-year-old man drank liquor mixed with 45%methanol and 35%alcohol.His vision blurred 10 h later and he fell into coma in another 9 h.Serum toxicological tests were performed immediately,and continuous renal replacement therapy(CRRT)was carried out as the lactic acid exceeded 15 mmol/L and blood pH was 6.78.In addition,the toxicological report revealed 1300.5μg/mL of methanol in serum and 1500.2μg/mL in urine.After 59 h of CRRT,the methanol level decreased to 126.0μg/mL in serum and 151.0μg/mL in urine.However,the patient was still unconscious and his pupillary light reflex was slow.Computed tomography showed hemorrhage in the left putamen.After 16 d of life support treatment,putamen hemorrhage developed into diffuse symmetric intracerebral hemorrhage.In the end,his family gave up and the patient was discharged,and died in a local hospital.CONCLUSION Cerebral hemorrhage requires constant vigilance during the full course of treatment for severe cases of AMP.

Effects of Changtuoning and Xuebijing combined with hemoperfusion on serum inflammatory factors and myocardial enzymes in patients with acute severe organophosphorus poisoning

Objective:To investigate the effects of Changtuogning and Xuebijing combined with hemoperfusion on serum inflammatory factors and myocardial enzymes in patients with acute severe organophosphorus pesticide poisoning (AOPP).Methods: A total of 92 patients with acute severe AOPP who were admitted to our hospital from July 2015 to June 2018 were enrolled. All patients were divided into the observation group and the control group by randomized block method (n=46). The control group was treated with Changtuoning and Xuebijing, and the observation group was treated with Changtuoning and Xuebijing combined with blood perfusion. The clinical indexes, serum inflammatory factors, myocardial enzyme indexes, complications and adverse reactions were compared between the two groups.Results:The doses of atropine, recovery waking time, ChE recovery time and hospital stay in the observation group were significantly lower than those in the control group. The cure rate in the observation group was significantly higher than that in the control group (P<0.05). There was no significant difference between the two groups (P>0.05). The levels of TNF-α, IL-8 and IL-18 in the observation group were significantly lower than those in the control group (P<0.05). The levels of CK, CK-MB, LDH and AST in the observation group were significantly lower than those in the control group (P<0.05). The incidence of complications (intermediate syndrome, respiratory failure, pulmonary infection, pulmonary edema) in the observation group was significantly lower than that in the control group (P<0.05). The incidence of adverse reactions (myalgia, fatigue, digestive tract reaction, abnormal liver function) in the observation group was significantly lower than that in the control group (P<0.05).Conclusion:Changtuoning and Xuebijing combined with hemoperfusion have significant effects on patients with acute severe organophosphorus poisoning, which can effectively reduce inflammatory factors and improve myocardial enzyme index.

Acute kidney injury due to intravenous detergent poisoning:A case report

BACKGROUND Detergent poisoning mostly occurs through oral ingestion(>85%),ocular exposure(<15%),or dermal exposure(<8%).Reports of detergent poisoning through an intravenous injection are extremely rare.In addition,there are very few cases of renal toxicity directly caused by detergents.Here,we report a unique case of acute kidney injury caused by detergent poisoning through an accidental intravenous injection.CASE SUMMARY A 61-year-old man was intravenously injected with 20 mL of detergent by another patient in the same room of a local hospital.The surfactant and calcium carbonate accounted for the largest proportion of the detergent.The patient complained of vascular pain,chest discomfort,and nausea,and was transferred to our institution.After hospitalization,the patient’s serum creatinine level increased to 5.42 mg/dL,and his daily urine output decreased to approximately 300 mL.Renal biopsy findings noted that the glomeruli were relatively intact;however,diffuse acute tubular injury was observed.Generalized edema was also noted,and the patient underwent a total of four hemodiafiltration sessions.Afterward,the patient’s urine output gradually increased whereas the serum creatinine level decreased.The patient was discharged in a stable status without any sequelae.CONCLUSION Detergents appear to directly cause renal tubular injury by systemic absorption.In treating a patient with detergent poisoning,physicians should be aware that the renal function may also deteriorate.In addition,timely renal replacement therapy may help improve the patient’s prognosis.

Nurse’s knowledge, attitude and practice on the initial management of acute poisoning among adult casualties: Study at Kenyatta National Hospital, Kenya

The purpose of this study was to determine nurse’s knowledge, attitude and practice on the initial management of acute poisoning among adult casualties seen at Accident and Emergency Department (AED), Kenyatta National Hospital (KNH). The study was cross sectional. Both qualitative and quantitative methods of data collection were employed. The target population were all nurses working at AED, KNH. Purposive sampling was used to select study subjects. Sample size included all Accident and Emergency (A&E) nurses who met subject’s inclusion criteria. Structured questionnaires, observation checklist and interview were used to collect the data. Sixty eight (82%) of A&E nurses participated in this study. The study found out that with higher nursing qualification and training on courses related to emergency care, knowledge and skills of A&E nurses on the initial management of acute poisoning is enhanced. A&E nurses with lower education level had a higher mean score of positive attitude compared with nurses with higher nursing qualification. Majority 60 (88.2%) of the A&E nurses indicated that, they required more training on the initial management of acute poisoning. Study recommends that A&E nurses should be trained on various types of poisoning including;assessment, clinical presentations and management to include gut decontaminations. In addition, refresher courses should be organised for those already trained. Flowcharts that will enhance easy identification and management of poisoned casualties should be put in place and utilized accordingly.

Risk factors and optimal predictive scoring system of mortality for children with acute paraquat poisoning

BACKGROUND There is no suitable scoring system that can be used to predict mortality in children with acute paraquat intoxication(APP).AIM To optimize a predictive scoring system for mortality in children with APP.METHODS A total of 113 children with APP from January 1,2010 to January 1,2020 were enrolled in this study.These patients were divided into survivors and nonsurvivors.We compared the clinical characteristics between the two groups and analyzed the independent prognostic risk factors.The survival rates of patients with different values of the pediatric critical illness score(PCIS)were assessed using kaplan-meier survival analysis.The best scoring system was established by using the area under the receiver operating characteristic curve analysis.RESULTS The overall mortality rate was 23.4%.All non-survivors died within 20 days;48.1%(13/27)died within 3 days,and 70.3%(19/27)died within 7 days.Compared to survivors,the non-survivors were older,had higher white blood cell count,alanine aminotransferase(ALT),aspartate aminotransferase,serum creatinine,blood urea nitrogen,glucose,and pediatric early warning score,and had lower platelet count,albumin,Serum sodium(Na+)and PCIS.ALT and PCIS were the independent prognostic risk factors for children with APP.The survival rate of children classified as extremely critical patients(100%)was lower than that of children classified as critical(60%)or noncritical(6.7%)patients.The specificity of ALT was high(96.51%),but the sensitivity was low(59.26%).The sensitivity and specificity of ALT combined with PCIS were high,92.59%and 87.21%,respectively.The difference in mortality was significantly higher for ALT combined with PCIS(area under the receiver operating characteristic:0.937;95%CI:0.875-0.974;P<0.05).CONCLUSION In our study,ALT and PCIS were independent prognostic risk factors for children with APP.ALT combined with PCIS is an optimal predictive mortality scoring system for children with APP.

Statistics of Acute Aluminium Phosphide Poisoning in Fez, Morocco

Aluminium phosphide is a rodenticide widely used in agriculture to protect grains and foods. Poisoning with this product represents a real problem in developing countries, as an interested young people and it causes high mortality. Aims of this study are to analysis epidemiological aspects, clinics, therapeutic, outcome of this acute poisoning and determine the factors of mortality. It is a retrospective study, concerned 47 patients intoxicated by the Aluminium phosphide between January 2009 and December 2012. It represents 23.4% of all poisonings. The mean age was 24.5 years with a female predominance （63.8%）. The poisoning was in a suicidal goal in 95.7% of cases. The mean ingested quantity was 3 grams. The initial clinical picture was dominated by vomiting, abdominal pain, shock and disorders of consciousness in 57.4%, 48.9%, 31.9% and 21.3%, respectively. Electrocardiogram abnormalities were observed in 38.3% of cases. Increase of Troponin was observed in 27.7% of cases. 36.2% of patients were intubated and ventilated and 40.4% have been placed under vasoactive drugs. The mortality rate was 38.3%. The prognostic factors were： delay of management, potassium disorders, elevated of Troponin, hypotension, tachycardia, need for mechanical ventilation, vasoactive drugs and shock. To improve the prognosis, the management should be rapid and the governement should focus more on prevention, so the aluminium phosphide will not be avaible to general population.

Effects of hemoperfusion combined with hemodialysis on target organ damage in patients with acute paraquat poisoning

Objective: To investigate the effects of hemoperfusion combined with hemodialysis on target organ damage in patients with acute paraquat poisoning. Methods: A total of 42 patients with acute paraquat poisoning who were admitted and treated in our hospital between December 2013 and October 2017 were selected as the research subjects, and their therapies were reviewed and used to divide them into the control group (n=20) who received hemoperfusion alone and the combined treatment group (n=22) who received hemoperfusion combined with hemodialysis. The differences in the levels of liver and kidney function indexes in peripheral blood as well as lung function indexes in arterial blood were compared between the two groups of patients immediately after admission, after 1 d of treatment and after 3 d of treatment. Results: Immediately after admission, the differences in the levels of liver and kidney function indexes in peripheral blood as well as lung function indexes in arterial blood were not statistically significant between the two groups. After 1d of treatment and after 3 d of treatment, kidney function indexes Scr, BUN and β2-MG levels in peripheral blood of combined treatment group were lower than those of control group at corresponding time points respectively;liver function indexes ALT, AST, TB and ALP levels in peripheral blood were lower than those of control group at corresponding time points respectively;lung function indexes PaO2, BE and PCO3- levels in arterial blood were higher than those of control group at corresponding time points respectively whereas PaCO2 levels were lower than those of control group at corresponding time points respectively. Conclusion: Compared with hemoperfusion alone, hemoperfusion combined with hemodialysis is more advantageous in protecting the functions of liver, kidney, lungs and other target organs of patients with acute paraquat poisoning.

Expression of heat shock protein 70 in lung tissuesof acute paraquat poisoned rats and interventionof ulinastatin

BACKGROUND： Paraquat （PQ） is an effective herbicide and is widely used in agricultural production, but PQ poisoning is frequently seen in humans with the lung as the target organ. Clinically pulmonary pathological changes are often used to predict the severity and prognosis of the patients. In this study, we observed the expression of heat shock protein 70 （HSP70） in rat lung after PQ poisoning and to investigate the therapeutic effects of ulinastatin.METHODS： Seventy-two adult healthy SD rats were randomly divided into a control group （group A, n=24）, a poisoning group （group B, n=24）, and an ulinastatin group （group C, n=24）. The rat models of acute PQ poisoning were established by intra-gastric administration of 80 mg/kg PQ to rats of groups B and C, and the rats of group C were intra-peritoneally injected with 100 000 IU/kg ulinastatin 30 minutes after poisoning. The expression of HSP70 in lung tissue was observed, and W/D and histopathological changes in the lung tissue were compared 12, 24, 48 and 72 hours after poisoning. The expression of HSP70 in the lung tissue was assayed by using RT-PCR. All quantitative data were processed with one-way analysis of variance to compare multiple sample means.RESULTS： Compared to group A, the expression of HSP70 in the lung of rats in groups B and C increased signi？ cantly at all intervals （P〈0.05）. The pathological changes in lung tissue of rats with PQ poisoning included congestion, leukocytes in？ ltration and local hemorrhage, whereas those of group C were signi？ cantly lessened.CONCLUSION： Ulinastatin may ameliorate acute lung injury to some extent after PQ poisoning in rats by enhancing the expression of HSP70.

Acute kidney injury from different poisonous substances

AIM To report our experience of acute kidney injury(AKI) developed after exposure to poisonous substance.METHODS Retrospective study where data was collected from case records of patients coming to this institute during January 1990 to May 2016.This institution is a tertiary care center for renal care in the metropolitan city of Karachi,Pakistan.History of ingested substance,symptoms on presentation,basic laboratory tests on arrival,mode of treatment and outcome were recorded from all patients and are presented here.Patients developing AKI after snake envenomation or scorpion stings are not included in this study.RESULTS During studied period 184 cases of AKI developing after poisoning were seen at our institution.The largest group was from paraphenyline diamine poisoning comprising 135 patients,followed by methanol in 8,organophosphorus compounds in 5,paraquat in 5,copper sulphate in 5,tartaric acid in 4,phenobarbitone in 3 and benzodiazipines,datura,rat killer,fish gall bladder,arsenic,boiler water,ammonium dichromate,acetic acid and herbs with lesser frequency.In 8 patients multiple substances were ingested in combination.Renal replacement therapy was required in 96% of patients.Complete recovery was seen in 72.28% patients,20% died during acute phase of illness.CONCLUSION It is important to report poisonous substances causing vital organ failure to increase awareness among general population as well as health care providers.

Evaluation of gastric lavage efficiency and utility using a rapid quantitative method in a swine paraquat poisoning model

BACKGROUND:Gastric lavage(GL)is one of the most critical early therapies for acute paraquat(PQ)poisoning;however,details of the treatment protocol remain to be established.METHODS:A rapid quantitative method involving sodium dithionite testing was developed.It was validated for the determination of the PQ concentrations in gastric juice and eluate samples from a swine acute PQ poisoning model with early or delay GL,or without.The vital signs,laboratory testing,and PQ plasma concentrations were collected for therapeutic effect evaluation.RESULTS:The reaction conditions of the test were optimized for two types of samples.Early GL at one hour(H1)could improve the signs and symptoms after acute PQ poisoning at 24 hours(H24).In contrast,GL at 6 hours(H6)could only partially relieve the vital signs.The H1 GL group effectively reduced the peak of the plasma PQ concentration.In addition,the PQ concentrations in the plasma and the gastric juice were significantly decreased in both the GL groups as compared to the untreated group at H24.Moreover,there was no significant difference in the washing efficiencies calculated from the total eluates between the two GL groups.However,the washing efficiency of the first 10 L eluate is superior to that of the additional 10 L eluate.CONCLUSION:GL only at early stage may it benefit PQ poisoning in an animal model.The currently used 20 L GL volume may need to be reduced in view of the low washing efficiency in the later 10 L eluate.The rapid quantitative method can be used for gastric juice sample and has a certain value for clinical GL practices.

The advantages of penehyclidine hydrochloride over atropine in acute organophosphorus pesticide poisoning:A meta-analysis

Background:Penehyclidine hydrochloride(PHC)has been used for many years as an anticholinergic drug for the treatment of acute organophosphorus pesticide poisoning(AOPP).The purpose of this meta-analysis was to explore whether PHC has advantages over atropine in the use of anticholinergic drugs in AOPP.Methods:We searched Scopus,Embase,Cochrane,PubMed,ProQuest,Ovid,Web of Science,China Science and Technology Journal Database(VIP),Duxiu,Chinese Biomedical literature(CBM),WanFang,and Chinese National Knowledge Infrastructure(CNKI),from inception to March 2022.After all qualified randomized controlled trials(RCTs)were included,we conducted quality evaluation,data extraction,and statistical analysis.Statistics using risk ratios(RR),weighted mean difference(WMD),and standard mean difference(SMD).Results:Our meta-analysis included 20,797 subjects from 240 studies across 242 different hospitals in China.Compared with the atropine group,the PHC group showed decreased mortality rate(RR=0.20,95%confidence intervals[CI]:0.16–0.25,P<0.001),hospitalization time(WMD=-3.89,95%CI:-4.37 to-3.41,P<0.001),overall incidence rate of complications(RR=0.35,95%CI:0.28–0.43,P<0.001),overall incidence of adverse reactions(RR=0.19,95%CI:0.17–0.22,P<0.001),total symptom disappearance time(SMD=-2.13,95%CI:-2.35 to-1.90,P<0.001),time for cholinesterase activity to return to normal value 50–60%(SMD=-1.87,95%CI:-2.03 to-1.70,P<0.001),coma time(WMD=-5.57,95%CI:-7.20 to-3.95,P<0.001),and mechanical ventilation time(WMD=-2.16,95%CI:-2.79 to-1.53,P<0.001).Conclusion:PHC has several advantages over atropine as an anticholinergic drug in AOPP.

Role of hemoperfusion combined with hemodialysis in acute severe organophosphorus pesticide poisoning:a meta-analysis

Background:Acute severe organophosphorus pesticide poisoning is a common severe emergency in developing countries.Our meta-analysis aimed to clarify the efficacy of hemoperfusion combined with hemodialysis on acute severe organophosphorus pesticide poisoning.Methods:Several databases were searched.After formulating relevant inclusion and exclusion criteria,qualified studies were included,and the data were extracted.The outcome indicators were the success rate of rescue,the time of hospitalization,the incidence of com-plications,the time for the cholinesterase level to return to normal,the coma time,and the atropine dosage.The results were analyzed using risk ratios,weighted mean difference,standard mean difference,and 95%confidence interval.The Cochrane Collaboration tool was used to assess the risk of bias in all the included studies.In terms of statistical methods,we used RevMan software(version 5.3;The Nordic Cochrane Centre,The Cochrane Collaboration,Copenhagen,Denmark)and Stata(versions 14 and 16;StataCorp,College Station,TX,USA)for the data analysis.Results:We included 92 randomized controlled trials with 6899 participants.Compared with the conventional emergency treatment group(CET group),the hemoperfusion group(HP+CET group),and the hemodialysis group(HD+CET group),the use of hemoperfusion combined with hemodialysis based on CET(HP+HD+CET group)significantly increased the success rate of rescue and reduced hos-pitalization time,the incidence of complications,time for cholinesterase level to return to normal,coma time,and atropine dosage.Conclusion:Hemoperfusion combined with hemodialysis is effective in the treatment of acute severe organophosphorus pesticide poi-soning.In the future,more scientifically designed,large-scale,high-quality,multicenter randomized controlled trials are needed to validate this study further.

阿托品联合连续静脉-静脉血液滤过及血液灌流治疗老年急性重症有机磷中毒的临床分析

目的分析老年急性重症有机磷中毒患者接受阿托品联合连续静脉-静脉血液滤过(CVVH)+血液灌流(HP)治疗方案的疗效。方法回顾性选取2019年1月—2022年1月于自贡市第一人民医院救治的老年急性重症有机磷中毒患者64例,根据不同救治方案将患者分为使用阿托品救治的对照组(32例)和使用阿托品联合CVVH+HP方案救治的观察组(32例)。2组均接受反复清洗胃部、甘露醇或硫酸镁导泻、大量吸氧、平衡电解质、应用胆碱酯酶复能剂氯磷定等常规急救措施,此外,对照组使用阿托品救治,观察组使用阿托品联合CVVH+HP方案救治。观察并比较2组恢复情况、胆碱酯酶(ChE)水平、心肝肾等脏器功能损伤程度评估值[心功能指标值:心肌肌钙蛋白I(cTnI)、心肌肌钙蛋白T(cTnT)、肌酸激酶同工酶(CK-MB);肝功能指标值:丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST);肾功能指标值:尿蛋白定量、尿素氮、血肌酐)];评估并比较2组机体氧化应激程度[人过氧化脂质(LPO)、丙二醛(MDA)、超氧化物歧化酶(SOD)水平]、局部炎症情况[白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)、降钙素原(PCT)水平]、不良事件、临床疗效以及缓解期严重并发症发生情况。结果与对照组比较,观察组患者清醒时间、机械通气时间、ChE活性恢复正常时间和住院时间均明显缩短,差异均有统计学意义(P<0.05)。治疗后,2组ChE水平均高于同组治疗前,且观察组ChE水平高于对照组,差异均有统计学意义(P<0.05)。治疗后,2组患者CK-MB、cTnI、cTnT、ALT、AST、尿蛋白定量、尿素氮、血肌酐水平均低于同组治疗前,观察组均低于对照组,差异均有统计学意义(P<0.05)。治疗后,2组患者LPO和MDA水平均低于同组治疗前,而SOD水平高于同组治疗前;观察组LPO和MDA水平均低于对照组,而SOD水平高于对照组,差异均有统计学意义(P<0.05)。治疗后,2组患者IL-1β、IL-6、PCT水平均低于同组治疗前,且观察组IL-1β、IL-6、PCT水平均低于对照组,差异均有统计学意义(P<0.05)。与对照组比较,观察组治疗不良事件发生率降低,而疗效升高,差异均有统计学意义(P<0.05)。与对照组比较,观察组IMS、反跳等严重并发症发生率降低,但2组差异无统计学意义(P>0.05)。结论阿托品联合CVVH+HP方案可降低老年急性重症有机磷中毒患者相关并发症的发生,促进ChE表达,抑制局部炎症,增强抗氧化能力,减少对脏器功能的损害,疗效较好,具有一定的临床应用价值。