內(nèi)科學(xué)教學(xué)課件：急性有機(jī)磷殺蟲藥中毒

1、Acute organic phosphorus insecticides poisoning 急性有機(jī)磷殺蟲藥中毒,Overview,OPI belong to organophosphate/有機(jī)磷酸酯or dithio phosphate ester/硫代磷酸酯類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/乙酰膽堿酯酶inhibition ,cause the accumulation of acetylcholine/乙酰膽堿.,rank poison /劇毒類：LD5010mg/kg phorate, phosphorus absorption and parathion /甲拌磷、內(nèi)吸磷、對硫磷 high poison /高毒類：LD50 10100mg/kg methyl parathion, methamidophos, dichlorvos/甲基對硫磷、甲胺磷、敵敵畏 moderate poison /中毒類：LD50 1001000mg/kg dime

3、thoate, trichlorfon/樂果、敵百蟲 low poison /低毒類：LD50 10005000mg/kg mara sulphur phosphorous /馬拉硫磷,Category,Etiology Occupational poisoning Production, using Living poisoning,Etiology severe person convulsions or coma. Serious breathing, circulation central inhibition and death /輕者頭暈，頭痛，情緒不穩(wěn)；重者抽搐昏迷， 嚴(yán)重者呼吸

4、、循環(huán) 中樞抑制而死亡。,Clinical manifestation,4.Local lesion sensitization dermatitis/過敏性皮炎，exfoliative dermatitis/剝脫性皮炎,（二）Delayed polyneuropathy/遲發(fā)性多發(fā)神經(jīng)?。?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. 中毒癥狀消失后23周出現(xiàn)的感覺、運動型多發(fā)性神經(jīng)病變，主要累及肢體末端、可有下肢癱瘓、四肢肌肉萎縮等。 mechanism:organophosphorus pesticide inhibit nerve target esterase and aging /有機(jī)磷殺蟲劑抑制神經(jīng)靶酯酶并使其老化。,Clinical manifestation,（三）Intermediate syndrome/中間型綜合征 Occur within 24-96 h after poisoning,between the cholinergic crisis and

6、 late-onset neuropathy / 發(fā)生于中毒后24-96h，在膽堿能危象和遲發(fā)性神經(jīng)病之間。,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 /屈頸肌，肢體近端肌，顱神經(jīng)、支配的肌肉無力，重者累及呼吸肌。表現(xiàn)：抬頭困難，眼瞼下垂，睜眼困難，咀嚼肌無力，聲音嘶啞，吞咽困難，呼吸肌麻痹 Mechanism:cholinesterase affected by long-term suppression,impact the nerve - muscle postsynaptic joint function . /膽堿酯酶受到長期抑制，影響神經(jīng)

8、肌肉接頭處突觸后功能,Determination of blood cholinesterase activity/膽堿酯酶活力測定 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 /毒蕈堿樣癥狀 Moderate poisoning, muscarinic signs +nicotine signs , ChE down to about 50-30% of normal./毒蕈堿煙堿樣癥狀 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、肺水腫、腦水腫,Degree classification,Treatment,Cleaning the poisoning Take away from the scene Cleaning the skin， hair and nails Gastric lavage：Trichlorfon avoid alkaline drugs /敵百蟲忌堿性藥，Parathion avoid potassium permanganate /對硫磷忌高錳酸鉀 C

11、atharsis,Emergency recovery/緊急復(fù)蘇 Pneumonedema, respiratory muscle paralysis, respiratory failure ，cardiac arrest/肺水腫，呼吸肌麻痹，呼吸衰竭，心臟驟停,Antidote/解毒藥 Principles：use antidotes as soon as possible, in sufficient quantities, coadunation and repeat. Cholinesterase reactivator/膽堿酯酶復(fù)活劑：Oxime compounds,remove

12、nicotine toxic effects /肟類化合物，解除煙堿樣毒性作用. pralidoxime chloride, pralidoxime iodide obidoxime Chloride/氯解磷定、碘解磷定、雙復(fù)磷,Cholinoceptor blocking drugs/膽堿受體拮抗藥 （1）M cholinergic antagonistsatropine，anisodamine/山莨菪堿 Alleviate muscarinic symptoms and against respiratory central inhibition /緩解毒蕈堿樣癥狀和對抗呼吸中樞抑制 Pr

13、inciples: Atropine，gradually reduced，to maintain the dosage 阿托品化、逐漸減量、維持用量,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：瞳孔擴(kuò)大、口干、皮膚干燥、心率增快、肺部濕羅音消失。 Atropine poisoning: pupils significantly

14、 expanded, consciousness, dysphoria, convulsions, coma, urinary retention. /阿托品中毒：瞳孔明顯擴(kuò)大、神志模糊、煩躁不安、抽搐、昏迷、尿潴留。,（2）N cholinergic antagonists -scopolamine /東莨菪堿 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/低鉀血癥 arrhythmia/心律失常