摘要
毒死蜱是近年来广泛应用的一种新型有机磷杀虫剂,自杀是导致急性毒死蜱中毒的主要原因。毒死蜱抑制胆碱酯酶的作用明显,且胆碱酯酶活性恢复缓慢。评估毒死蜱中毒患者的严重程度必须综合参考胆碱酯酶活力、血浆乳酸水平以及中毒严重程度评分、急性生理和慢性健康评分Ⅱ等。对于毒死蜱中毒的治疗方法有很多,但均存在优缺点:洗胃和血液灌流清除毒死蜱的作用仍有较大争议;阿托品、氯解磷定的解毒效果欠佳;氯化镁可通过抑制乙酰胆碱释放,中和毒死蜱毒性;脂肪乳剂可阻止毒死蜱与受体结合,减轻肺部损伤和心脏损伤;褪黑素、咖啡酸苯乙酯、磷酸二酯酶抑制剂等可调节氧化应激和细胞凋亡,降低毒死蜱所致的肝脏损伤。
Chlorpyrifos is a new organophosphorus insecticide which is widely used all over the world in recent years.It accounts for many acute poisoning each year,which are mainly attributed to suicide.Chlorpyrifos obviously inhibits cholinesterase,and the activity of cholinesterase recovers slowly.In order to evaluate the severity of chlorpyrifos poisoning,the cholinesterase activity, plasma lactic acid level and poisoning severity score,acute physiological and chronic health score Ⅱ should be taken into account.There are many methods to treat chlorpyrifos poisoning,each with different advantages and disadvantages :the effects of gastric lavage and hemoperfusion on the clearance of chlorpyrifos are still controversial:atropine,pyraloxime methylchloride have poor detoxification effect;magnesium chloride can neutralize the toxicity of chlorpyrifos by inhibiting acetylcholine release;lipid emulsion prevents chlorpyrifos from binding to receptors and reduces lung and heart damage;melatonin,phenethyl caffeate and phosphodiesterase inhibitor can regulate oxidative stress and apoptosis to reduce liver damage induced by chlorpyrifos.
作者
张明浩
付国强
田小溪
王伯良
ZHANG Minghao;FU Guoqiang;TIAN Xiaoxi;WANG Boliang(Department of Emergency,the Second Affiliated Hospital of Air Force Military Medical University, Xi′an 710038,China)
出处
《医学综述》
2019年第4期763-768,共6页
Medical Recapitulate
关键词
毒死蜱
胆碱酯酶
血液灌流
氯化镁
脂肪乳剂
Chlorpyrifos
Cholinesterase
Hemoperfusion
Magnesium chloride
Lipid emulsion
