内科学 有机磷农药中毒-吕玲 (英文)

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1、ORGANOPHORUSPESTICIDESPOISONINGLVLINGDEPARTMENTOFOCCUPATIONALDISEASEHUASHANHOSPITALFUDANMEDICALCOLLEGE1SpecificPropertiesBasicchemicalstructuresR1－OR2－OPYX2PhysicalandchemicalpropertyAoilorcrystallinesubstance,thatisyellowtobrownpossessinganunpleasantsmell.Insolubleinwater;solubleinorganicliq

2、uid.Easilydissolvedinalkalizingcondition.3DegreeoftoxicityManyofthemarehighlyorextremelytoxic.4ExposuresituationsOccupationalEnviromental5AbsorbandMetabolismAbsorb-Maybeabsorbedthroughrespiratoryordigestivetract-Alsothroughskin.Metabolism-Mainlyintheliver-byoxidation,detoxicationprocesses6Mec

3、hanismoftoxicactionTheAChE(acetylcholinesteraseofcholinesterase)isinhibited.OrganophoruscombinestheAChE,resultingorganophosphate-cholinesterase.causingacumilationofacetylcholine.7ClinicalmanifestationsAcutepoisoning-Muscarinicsign:presentedwithconstraction,excessivelacrimalsecretion-Nicotinic

4、sign：Excessiveaccumulationof-CentralnervoussystemsignsAChEinneuromusculartransmission8Degreeofpoisoning-Mildpoisoning：Msign-Moderatepoisoning：Nsign,muscularfibrillation-Heavypoisoning：coma、pulmonaryedemabreathparalysis、brainedema9OrganophosphateInducedDelayedPolyneuropathy(OPIDP)2～3weeks（4～45

5、days）afterdisappearanceofacutesymptoms.ItisnotrelatedtotheinhibitionofChE，butisrelatedtoinhibitionofneuropathytargetedNTE.10-Progressivestage:-Stablestage：3-12months.-Remissionstage：6-18months.11Intermediatesyndrome24～96hoursafteracutepoisoning，muscleparalysis.ItisrelatedtolonginhibitionofChE

6、（delayeliminationofpesticides,notduetoenoughdrug,solubleinorganicliquid).Skindamage12LaboratoryTestingCHEinwholeblood-Specificmarkfororganophoruspesticidepoisoning.-mildpoisoning:ChE50～70％oftheactivityinnormalindividuals；-moderate:30～50％-heavy:＜30％13metabolismproductsinurineEMG14DiagnosisExpo

7、surehistoryClinicalmanifestations：M,NsignsandCNSDeterminationofChEactivity：〈50%Responsetospecifictreatments15DifferentialdiagnosesMuscarinicTetrodotoxinHeatillnessAcutegastrointestinalinflammationBraininfectionOtherpesticides16TreatmentMakedi