Severe Organophosphorus Pesticide Poisoning Research Articles

Evaluation and Use of Organs from Donors Poisoned by Organophosphorus Pesticide.

BACKGROUND The aim of this study was to explore the evaluation and use of donor organs from donors with brain death caused by acute severe organophosphorus pesticides and provide a basis for the use of such donor organs. MATERIAL AND METHODS Seven cases of brain dead donors caused by acute organophosphorus pesticide poisoning from January 2014 to December 2018 in the hospital were collected, and a retrospective analysis was made of the donors' age, race, physiological and pathological changes, donor organ function changes and the organ use, liver or kidney function recovery, and complications of the recipients. The 18 recipients were followed up until June 31, 2022. RESULTS We found that 71.42% of organ donors were male, and 71.42% of organ donors were under 50 years old. The main cause of death was respiratory failure caused by organophosphorus pesticide poisoning. The liver and kidney functions of 7 donors were damaged, and 3 livers could not be used due to severe functional damage, but the liver or kidney function of 18 recipients gradually recovered after transplantation. Delayed recovery of graft function occurred after transplantation accounted for 21.43%, and the grafts had good short-term to medium-term performance. CONCLUSIONS Although the function of organs from donor with brain death due to acute severe organophosphorus pesticide poisoning is seriously damaged, most of the organs can still be used for transplantation. Individualized functional maintenance according to the situation of donors is conducive to improving the quality of organs.

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

Abstract 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 complications, 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 hospitalization 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 poisoning. In the future, more scientifically designed, large-scale, high-quality, multicenter randomized controlled trials are needed to validate this study further.

Study on the Effectiveness and Complication Rate of Hemoperfusion and Hemodialysis in the Treatment of Emergency Patients with Severe Organophosphorus Pesticide Poisoning

Study on the Effectiveness and Complication Rate of Hemoperfusion and Hemodialysis in the Treatment of Emergency Patients with Severe Organophosphorus Pesticide Poisoning

Hemoperfusion in combination with hemofiltration for acute severe organophosphorus pesticide poisoning: A systematic review and meta-analysis.

Background:Acute severe organophosphorus pesticide poisoning (ASOPP) is one of the major diseases that endanger human life and health. However, the effects of conventional therapy including gastric lavages, mechanical ventilation, muscarinic antagonist drugs, and cholinesterase reactivators were uncertain. This meta-analysis aims to investigate the safety and efficacy of hemoperfusion combined with hemofiltration besides routine therapy for ASOPP.Materials and Methods:A comprehensive search for candidate publications was performed through PubMed, Medline, Cochrane Library, WanFang, Chinese Biomedical Literature, and China National Knowledge Infrastructure from database inception to May 12, 2020. The retrieved studies were screened by the predefined inclusion and exclusion criteria. The data of important end points were extracted. The risk ratio (RR) and weighted mean difference (WMD) were pooled for categorical variables and continuous variables, respectively. Meta-analyses and publication bias were conducted by using STATA software version 15.1.Results:A total of 11 randomized controlled trials with 811 patients were included. Compared to conventional therapy group, patients in the hemoperfusion plus hemofiltration group were significantly superior with regard to mortality (RR 0.38, 95% confidence interval [CI] [0.25, 0.57], P < 0.001), total atropine dosing (WMD −147.34 mg, 95% CI [−199.49, −95.18], P < 0.001), duration of mechanical ventilation (WMD −2.34 days, 95% CI [−3.77, −0.92], P < 0.001), cholinesterase recovery time (WMD −2.49 days, 95% CI [−3.14, −1.83], P < 0.001), and length of stay (WMD −4.52 days, 95% CI [−5.31, −3.73], P < 0.001).Conclusion:Combined hemoperfusion and hemofiltration was a very safe and effective treatment protocol for ASOPP, not only resulting in significantly decreased mortality but also resulting in reduced total atropine dosing, duration of mechanical ventilation, cholinesterase recovery time, and length of stay.

Changes of intestinal mucosal barrier function and effects of early enteral nutrition in patients with severe organophosphorus poisoning

Objective: To observe the changes of intestinal barrier function in patients with acute severe organophosphorus pesticide poisoning (ASOPP) and the effect of early enteral nutrition on them. Methods: A single-center, single-sample, prospective, randomized controlled clinical trial was conducted. A total of 50 patients with ASOPP were divided into 24 h enteral nutrition group (group A) and 48 h (48-72 h) enteral nutrition group (B group) according to the order of hospitalization. The two groups received equal calorie nutritional support, and Serum D-lactic acid (D-LA) and serum human diamine oxidase (DAO) were detected immediately after admission and at 48 h, 72 h and 144 h. At the same time, the worst value of APACHE-Ⅱ score was recorded, and the correlation between DAO, D-LA and APACHE-Ⅱ score was analyzed. The serum concentration of D-LA and DAO in 15 healthy adults were detected as healthy control group. Results: There was no statistical difference in gender, age, poisoning time and organophosphorus pesticide components between group A and B (P>0.05). The distribution of D-LA concentration in group A poisoned patients at admission, 48 h, 72 h and 144 h was (66±19) μg/L, (68±21) μg/L, (66±19) μg/L, (63±17) μg/L, while in group B they were (62±15) μg/L, (58±17) μg/L, (58±16) μg/L, (67±9) μg/L. There was no statistical difference between the two groups in D-LA concentration and that of healthy people [(67±17) μg/L, P>0.05]. The distribution of DAO concentration in group A poisoned patients at admission, 48 h, 72 h and 144 h was (2.1±0.6) μg/ml, (2.1±0.5) μg/ml, (2.2±0.4) μg/ml, (2.2±0.5) μg/ml, while in group B they were (2.1±0.5) μg/ml, (2.1±0.5) μg/ml, (2.2±0.5) μg/ml, (2.1±0.4) μg/ml. DAO concentration in the early stage of the intoxication of the two groups were higher than that of healthy people (0.1±0.0 μg/ml) (P<0.05). There is no statistical difference in DAO concentration between group A and B at different time points (P>0.05). The APACHEE-Ⅱ score of 48 hours and 72 hours in group A (12.2+1.7, 5.5+2.1) was significantly lower than that in group B (14.1+2.4, 8.2+2.6) (P<0.05). D-LA, DAO concentration at different time points was not correlated with APACHE-Ⅱ score (P>0.05). D-LA (r, P) was immediate admission (-0.17, 0.24), 48 h (0.04, 0.79), 72 h (0.32, 0.06), 144 h (0.29, 0.07), and DAO (r, P) was immediate admission (-0.12, 0.43), 48 h (0.02, 0.92), 72 h (0.03, 0.85), 144 h (0.03, 0.82). Conclusions: Patients with ASOPP may have obvious injury at intestinal mucosa at early stage (144 h), but the intestinal permeability is normal. Early enteral nutrition therapy can promote the recovery of patients, but has low correlation with intestinal barrier function improvement.

Observation of the effect of blood perfusion combined with penehyclidine hydrochloride injection in the treatment of acute severe organophosphorus pesticide poisoning

Objective To explore the clinical effect of blood perfusion combined with penehyclidine hydrochloride injection in the treatment of acute severe organophosphorus pesticide poisoning. Methods 58 patients with severe organophosphorus pesticide poisoning were selected as the research subjects.By using digital table method, they were randomly divided into observation group and control group, 29 cases in each group.The two groups were given conventional treatment and blood perfusion treatment after admission, the observation group was treated with penehyclidine hydrochloride injection on this base.Before and after treatment, the myocardial enzymes, liver, kidney function index, blood gas analysis, cholinesterase activity, as well as other treatment of the two groups were observed, and the results were compared. Results Compared with the control group, after treatment, the myocardial enzyme, transaminase, serum amylase and creatinine levels in the observation group were significantly lower, cholinesterase level was significantly increased, the oxygen partial pressure increased, the partial pressure of carbon dioxide decreased obviously, the differences were statistically significant(all P<0.05). The hospitalization time and cholinesterase activity recovery time of the observation group were significantly shorter than those of the control group[(12.57±2.14)d vs.(16.35±2.73)d, (5.46±2.29)d vs.(7.61±3.47)d], and the cure rate of the observation group was significantly higher than that of the control group(100.00% vs.82.76%), the differences were statistically significant(t=2.139, 2.208, χ2=5.472, all P<0.05). Conclusion Blood perfusion can directly adsorb organophosphorus pesticide, shorten the recovery time of cholinesterase and reduce the case fatality rate, and it combined with penehyclidine hydrochloride injection not only can improve the clinical curative effect of blood perfusion, but also can protect the organ. Key words: Poisoning; Pesticides; Organophosphorus compounds; Perfusion; Penehyclidine hydrochloride

Curative effect observation of Depmas dual blood purification for severe acute organic phosphorus poisoning

Objective To observe the clinical curative effect of Depmas double blood purification system for acute severe organophosphorus pesticide poisoning.Methods Retrospectively study was carried out on 147 patients of acute severe organophosphorus pesticide poisoning.Patients were divided into four groups,the conventional treatment group treated with drug therapy,hemoperfusion group given HA230 hemoperfusion in addition to conventional treatment,plasma exchange combined with hemoperfusion group given HA230 hemoperfusion and plasma exchange therapy in addition to conventional treatment,and Depmas group treated with plasma separation by Baxter blood fiber and then given series HA230 and BS330 hemoperfusion treatment on the separated plasma in addition to conventional treatment.Survival rate,mean survival time of death patients,the concentration changes of cholinesterase and bilirubin in peripheral blood were observed.Results Compared to the conventional treatment group,survival rates of hemoperfusion group,hemoperfusion combined with plasma exchange group and Depmas group were higher,the mean survival time was longer,the cholinesterase concentration in peripheral blood was higher and the elevated bilirubin concentration was decreased with the differences statistically significant (P＜0.01).Compared to hemoperfusion group,the survival rates of hemoperfusion combined with plasma exchange group and Depmas group were higher,the mean survival time was longer,the cholinesterase concentration in peripheral blood were higher and the elevated bilirubin concentration was decreased with the differences statistically significant (P＜0.05).Besides,there were no significant differences between the survival rate,mean survival time,peripheral blood cholinesterase and bilirubin concentration of hemoperfusion combined with plasma exchange group and that of Depmas group (P＞0.05).Conclusions Depmas dual blood purification system has remarkable curative effect for the treatment of acute severe organophosphorus poisoning. Key words: Hemoperfusion; Plasma exchange; Depmas double blood purification; Severe organophosphorus pesticide poisoning

Effects of different blood purification methods on serum cytokine levels and prognosis in patients with acute severe organophosphorus pesticide poisoning.

The aim of the present study was to investigate the impact of three different blood purification methods, hemoperfusion (HP), continuous blood purification (CBP), and on-line high-volume hemodiafiltration (OL-HDF), on the survival rate of patients with acute severe organophosphorus pesticide poisoning (ASOPP), as well as on major pro-inflammatory (interleukin [IL]-1, IL-6, tumor necrosis factor-α [TNF-α]) and anti-inflammatory (IL-10) cytokines in the serum. Eighty-one ASOPP patients were randomly divided into three groups: HP (N = 23), HP + CBP (N = 26), HP + OL-HD (N = 32). Serum IL-1, IL-6, TNF-α, and IL-10 levels were assessed by ELISA before treatment and at 24 and 48 h post-treatment and survival rates were determined. Patient survival rate was significantly higher in OL-HDF and CBP treated patients compared with HP group (P < 0.05). A significantly greater clearance effect in serum IL-1, IL-6, and TNF-α levels at 24 and 48 h post-treatment was observed in CBP and OL-HDF groups compared with the HP group (P < 0.05). The levels of serum anti-inflammatory cytokine IL-10 increased significantly in CBP and OL-HDF groups compared with the HP group (P < 0.05 at 48 h post-treatment). In addition, OL-HDF treatment achieved similar changes in serum TNF-α, IL-1, IL-6 and IL-10 levels as CBP (P > 0.05). Compared with the HP method, CBP or OL-HDF combined with HP can rapidly clear inflammatory cytokines, reduce systemic inflammatory response syndrome, and improve the survival of ASOPP patients. Compared with CBP, OL-HDF is an economical and effective method to treat ASOPP with less technical difficulty and more suitability for rural areas and primary hospitals.

Observation on curative effect of CRRT in treatment for acute severe organophosphorus pesticide poisoning

Objective To explore the clinical curative effect of CRRT in acute severe organophosphorus pesticide poisoning treatment.Methods 21 cases of acute severe organophosphorus pesticide poisoning from February 2011 to February 2012 in our emergency department were chosen as the experiment group,given CRRT based on conventional treatment,other 30 patients with acute severe organophosphorus pesticide poisoming from October 2009 to January 2011 in our hospital were selected as control group,with the routine treatment.The following indexes in the two groups were analyzed and compared:coma time,cholinesterase activity,recovery time,intermediate syndrome incidence rate,average hospitalization time,cure rate and the mean survival time of death patients.Results As for the experiment group,we had coma duration (11.52-3.93) hours,cholinesterase activity recovery time (5.04 ± 1.72) days,the average hospitalization time (8.36±1.29) days,intermediate syndrome incidence (6.58％),the cure rate (93.3％),dead patients with a mean survival time of (13.22 ± 2.83) days,and there were significant differences compared to those of control group (P＜0.05).Conclusion CRRT can obviously improve the clinical curative effect in severe acute organic phosphorus poisoning. Key words: CRRT; Severe acute organic phosphorus poisoning

Application of penehyclidine hydrochloride and naloxone in children with severe organophosphorus pesticide poisoning

目的 观察盐酸戊乙奎醚(长托宁)、纳洛酮治疗小儿重度有机磷农药中毒的疗效.方法 选择2001年5月至2009年11月在我院儿科住院的重度有机磷农药中毒伴昏迷、心肌酶谱升高的58例患儿作为研究对象,按使用与未使用长托宁、纳洛酮分为观察组与对照组,对两组临床疗效进行回顾性综合比较分析.结果 观察组在意识恢复时间、胆碱酯酶活力恢复正常时间、临床中毒症状消失时间、住院天数等方面均显著短于对照组(P＜0.01);病死率显著低于对照组(P＜0.05).两组治疗后心肌酶谱CK、CK-MB、AST及心肌肌钙蛋白Ⅰ较治疗前均有显著下降(P＜0.01),观察组较对照组下降更为显著(P＜0.01).结论 长托宁、纳洛酮治疗重度有机磷农药中毒能提高疗效,缩短病程,降低病死率,可保护重要脏器。

Application of penehyclidine hydrochloride in children with severe organophosphorus pesticide poisoning

目的 探讨盐酸戊乙奎醚治疗小儿重度有机磷农药中毒的剂量、疗效、不良反应等.方法 将重度有机磷农药中毒患儿62例随机分为治疗组32例,对照组30例.治疗组予以反复洗胃、盐酸戊乙奎醚、解磷定等治疗,对照组予以反复洗胃、阿托品、解磷定等治疗.结果 与对照组相比,治疗组的中毒症状消失时间为(13.2±5.9)h、血胆碱酯酶活力恢复至＞60%的时间为(16.1±11.4)h,住院时间为(7.1±2.8)d,临床治愈率93.8%,不良反应发生率15.6%,均明显优于对照组[(24.7±9.6)h、(35.2±14.5)h、(11.1±4.2)h、80%、70%](P＜0.05).结论 盐酸戊乙奎醚用于治疗小儿有机磷中毒,较阿托品具有明显的优越性,剂量小,起效快,半衰期长,用药次数少,疗效确切,不良反应少,可作为首选的抗胆碱药。

Rescue mechanical ventilation in acute organophosphorus pesticide poisoning with respiratory failure of 47 Cases

Objective To investigate the mechanical ventilation in the treatment of severe organophosphorus pesticide poisoning in the clinical significance of respiratory failure.Methods Uinical data of admitted to our hospital with severe organophosphorus pesticide poisoning respiratory failure in 83 cases were analyzed,according to whether mechanical ventilation,they were divided into treatment group(47 cases) and control group 36 cases,the efficacy were observed.Both groups were given routine gastric lavage,atropine,PAM,and symptomatic supportive care and other comprehensive measures,the treatment group,was given an extra mechanical ventilation.Results The treatment group had significantly higher success rate of resuscitation,the two groups were significantly different (P＜0.05).Conclusion Early establishment of artificial airway mechanical ventilation is a key step to rescue organophosphate pesticide poisoning,and respiratory failure to rescue key. Key words: Respiration,artificial; Respiratory insufficiency; Poisoning; Insecticides,organophosphate.

Therapeutic efficacy of hemoperfusion combined with comtinuous vein-vein hemofiltration in treatment of acute severe organophosphorus pesticide poisoning

目的 评价血液灌流加连续性静脉-静脉血液滤过治疗重度有机磷中毒的价值.方法 53例AOPP患者分为两组,对照组21例行传统治疗,治疗组32例在常规治疗基础上联合运用血液灌流及持续静-静脉血液滤过治疗.观察比较两组的治疗效果.结果 治疗组的昏迷持续时间、胆碱酯酶活力恢复时间、住院时间、阿托品应用总量均小于对照组,有显著性差异(P＜0.01).反跳发生率、中间综合症发生率均小于对照组,有显著性差异(P＜0.0 5).结论 血液灌流加连续性静脉-静脉血液滤过治疗重度有机磷中毒更为安全而有效。

Clinical observation of bedside hemoperfusion and repeated gastrolavage and purgation on acute severe organophosphorus pesticide poisoning

目的 研究血液灌流联合洗胃、导泻治疗急性重度有机磷农药中毒的效果.方法 回顾性分析自2003年7月至2006年6月重度有机磷农药中毒病历资料完整的72例临床资料.全部病例均在急诊科洗胃及内科常规处理后转入ICU并给予血液灌流治疗,将内科常规治疗、血液灌流同时再次反复洗胃、导泻的34例作为治疗组,将仅内科常规治疗、血液灌流,未再次洗胃、导泻的38例作为对照组.结果 治疗组治疗开始至清醒时间,氯磷定、阿托品用量,住院时间均较对照组明显减少,治愈率提高,两组比较差异有统计学意义.结论 内科常规治疗加早期血液灌流治疗急性重度有机磷农药中毒安全有效,早期血液灌流同时反复洗胃、导泻,可以进一步提高治愈率。

Early management after self-poisoning with an organophosphorus or carbamate pesticide – a treatment protocol for junior doctors

Severe organophosphorus or carbamate pesticide poisoning is an important clinical problem in many countries of the world. Unfortunately, little clinical research has been performed and little evidence exists with which to determine best therapy. A cohort study of acute pesticide poisoned patients was established in Sri Lanka during 2002; so far, more than 2000 pesticide poisoned patients have been treated. A protocol for the early management of severely ill, unconscious organophosphorus/carbamate-poisoned patients was developed for use by newly qualified doctors. It concentrates on the early stabilisation of patients and the individualised administration of atropine. We present it here as a guide for junior doctors in rural parts of the developing world who see the majority of such patients and as a working model around which to base research to improve patient outcome. Improved management of pesticide poisoning will result in a reduced number of suicides globally.