中毒中英文版专家讲座.pptx

,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,Acute organic phosphorus,insecticides,poisoning,急性有机磷杀虫药中毒,中毒中英文版,第1页,Overview,OPI,b,elong 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 acetylcholine enzyme/,乙酰胆碱酯酶,inhibition,cause the accumulation of acetylcholine,/,乙酰胆碱,.,中毒中英文版,第2页,rank poison,/,剧毒类,：,LD50,10mg/kg,phorate,phosphorus absorption and parathion/甲拌磷、内吸磷、对硫磷,high,poison,/,高毒类,：,LD,50,10100mg/kg,methyl parathion,methamidophos,dichlorvos/甲基对硫磷、甲胺磷、敌敌畏,moderate poison,/,中毒类,：,LD,50,1001000mg/kg,dimethoate,trichlorfon/乐果、敌百虫,low,poison,/,低毒类,：,LD,50,10005000mg/kg,mara sulphur phosphorous/马拉硫磷,Category,中毒中英文版,第3页,Etiology,Occupational poisoning,Production,using,Living poisoning,Etiology&Mechanism,中毒中英文版,第4页,Toxic absorption,metabolism and discharge,毒物吸收、代谢与排出,OPI,Body,Liver,Oxidation,Deduction,Hydrolysis,Conjugation,Discharge via kidney,GI tract,Respiratory tract,Skin,etc.,Blood,Respiratory tract,GI tract,Skin,Mucosa,Biotransformation,中毒中英文版,第5页,Mechanism,/,发病机制,True cholinesterase/真性胆碱酯酶：,CNS Gray matter、,RBC,、,sympathetic ganglion end plate movement/,CNS,灰质、,RBC,、交感神经节,、,运动终板,Pseudo cholinesterase/假性胆碱酯酶（丁酰胆碱酯酶）：,CNS white matter,serum,liver and intestinal submucosa/,CNS,白质、血清、肝、肠黏膜下层,水 解,正常生理状态下,：,乙酰胆碱,乙酸+胆碱,胆碱酯酶,中毒中英文版,第6页,Organophosphorus+cholinesterase/,有机磷胆碱酯酶,Phosphorus acylation cholinesterase,/,磷酰化胆碱酯酶,Inhibit cholinesterase,/,抑制胆碱酯酶,Acetylcholine decomposition,/,乙酰胆碱分解,Acetylcholine accumulation,/,乙酰胆碱堆积,Cholinergic nerve disorder,/,胆碱能神经紊乱,中毒中英文版,第7页,1.Muscarinic signs/,毒蕈碱（,M),样症状：Glands secretion increase,smooth muscle contraction,sphincter relaxation,performance:/腺体分泌增加,平滑肌收缩,括约肌松弛,（1）Sweating,salivate,tears,runny nose,lung,bubble,shortness of breath,difficulty breathing/多汗,流涎,流泪,流涕,肺部湿罗音,气促,呼吸困难,（2）,Miosis,nausea,vomiting,abdominal pain,diarrhea/,瞳孔缩小,恶心,呕吐,腹痛,腹泻,（3）Urinary and fecal incontinence/尿、便失禁,Clinical manifestation,(,一,)Acute cholinergic crisis,/,急性胆碱能危象,中毒中英文版,第8页,2.,Nicotinic signs/,烟碱（,N,）样症状：The sympathetic nervous excitement,adrenal medulla secretion/,交感神经兴奋，肾上腺髓质分泌。,High blood pressure,cardiac arrhythmia/血压高，心律失常,Skeletal muscle nerve-Muscle joint block,characterized by muscle tremors and muscle weakness,respiratory myoparalysis,lead to respiratory failure/,骨骼肌神经-肌肉接头阻断，表现为肌颤,肌无力，呼吸肌麻痹，造成呼吸衰竭。,Clinical manifestation,中毒中英文版,第9页,3.,CNS symptoms,dizziness,headaches,mood swings;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、循环 中枢抑制而死亡。,Clinical manifestation,中毒中英文版,第10页,4.Local lesion,sensitization dermatitis/,过敏性皮炎，,exfoliative dermatitis/,剥脱性皮炎,中毒中英文版,第11页,（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,limb muscle atrophy,etc.中毒症状消失后23周出现感觉、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,中毒中英文版,第12页,（三）,Intermediate syndrome/,中间型综合征,Occur within 24-96 h after poisoning,between the cholinergic crisis and late-onset neuropathy/发生于中毒后24-96,h,，在胆碱能危象和迟发性神经病之间。,Clinical manifestation,中毒中英文版,第13页,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 facial masticatory muscle weakness,voice hoarse,difficulty swallowing and breathing myoparalysis,/屈颈肌，肢体近端肌，颅神经、,、,、,支配肌肉无力，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.,/,胆碱酯酶受到长久抑制，影响神经肌肉接头处突触后功效,中毒中英文版,第14页,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,中毒中英文版,第15页,History of exposure to organophosphorus pesticides,Typical clinical manifestations,Laboratory test,：,ChE,urinary metabolite,Diagnosis,中毒中英文版,第16页,Mild poisoning,muscarinic signs,ChE,fell to 70-50%of normal/毒蕈碱样症状,Moderate poisoning,muscarinic signs,+nicotine s,ign,s,ChE,down to about 50-30%of normal./毒蕈碱烟碱样症状,Severe poisoning,i,n addition to the above s,ign,s,have coma,pulmonary edema and cerebral edema,ChE,dropped to below 30%of normal.,/,昏迷、肺水肿、脑水肿,Degree classification,中毒中英文版,第17页,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,Catharsis,中毒中英文版,第18页,Emergency recovery,/,紧急复苏,Pneumonedema,respiratory muscle paralysis,respiratory failure,，,c,ardiac arrest,/,肺水肿，呼吸肌麻痹，呼吸衰竭，心脏骤停,中毒中英文版,第19页,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 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,中毒中英文版,第20页,Cholinoceptor blocking drugs/,胆碱受体拮抗药,（,1,）,M cholinergic antagonists,atropine,，,anisodamine/,山莨菪碱,Alleviate,muscarinic,symptoms and against respiratory central inhibition/缓解毒蕈碱样症状和反抗呼吸中枢抑制,Principles,:Atropine,，,gradually reduced,，to maintain the dosage 阿托品化、逐步减量、维持用量,中毒中英文版,第21页,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 expanded,consciousness,dysphoria,convulsions,coma,urinary retention./阿托品中毒：瞳孔显著扩大、神志含糊、烦躁不安、抽搐、昏迷、尿潴留。,中毒中英文版,第22页,（,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,中毒中英文版,第23页,acidosis,/,酸中毒,hypokalemia,/低钾血症,arrhythmia/,心律失常,cerebral,edema/脑水肿,Symptomatic treatment/,对症治疗,中毒中英文版,第24页,Intermediate syndrome treatment,Artificial mechanical ventilation,Phosphate-solubilizing,/,解磷定1.0 g,im,2-3 days,中毒中英文版,第25页,复习思索题,1.,急性中毒怎样诊疗？,2.,急性中毒处理标准？,3.,有机磷农药中毒临床表现？,4.,有机磷农药中毒处理标准？,中毒中英文版,第26页,