Organophosphorus compounds belongs rau qeb ntawm tshuaj tua kab, uas yog tsim los rhuav tshem cov nroj tsuag, kab thiab nas.
Cov tshuaj tua kab no tau siv dav tsis yog hauv kev lag luam ua liaj ua teb xwb, tab sis kuj tseem nyob hauv lub neej txhua hnub. Ntau yam ntawm FOS muaj tshuaj lom heev thiab tuaj yeem ua rau muaj kev lom loj heev thaum lawv nkag mus rau hauv lub cev, thiab thaum lawv nkag mus rau hauv cov mucous daim nyias nyias ntawm nasopharynx thiab ob lub qhov muag, nrog rau cov tawv nqaij tsis zoo.
OPS lom txheeb cais
Kev mob hnyav nrog cov tshuaj organophosphorus ua tau yog thawj zaug ntawm lwm cov tshuaj lom exogenous, tsis tsuas yog qhov hnyav, tab sis kuj nyob rau hauv zaus. Kev tuag ntawm cov tshuaj lom no yog yuav luag 20%, thiab qhov zaus yog li 15% ntawm tag nrho cov mob.intoxication. Nws yog qhov txaus siab tias cawv yog ib hom tshuaj tua kab mob rau lom nrog organophosphorus tebchaw. Nyob rau hauv cov neeg raug tsim txom uas nyob rau hauv lub xeev ntawm qaug cawv heev thaum lub sij hawm ntawm lom nrog tshuaj tua kab, tus kab mob no yooj yim dua (convulsions thiab paresis ntawm lub pa cov leeg tsis muaj). Txawm li cas los xij, kev cuam tshuam hemodynamic tuaj yeem hais tau ntau dua.
Yuav ua rau muaj tshuaj tua kab tshuaj lom
Tshuaj lom nrog cov tshuaj organophosphorus tuaj yeem cuam tshuam nrog kev ua haujlwm thiab tshwm sim los ntawm kev tsis ua raws li cov cai tswj cov tshuaj lom. Kev tsis saib xyuas ntawm ib lossis ntau tus neeg tuaj yeem ua rau tsis yog tsuas yog ua rau lom lom rau lawv tus kheej xwb, tab sis kuj ua rau muaj kev lom zem ntau.
Ntxiv rau, kev tshuaj lom organophosphate tuaj yeem yog qhov xwm txheej hauv tsev. Qhov ua rau muaj xwm txheej yuav txawv, piv txwv li:
- tsis muaj npe ntawm cov thawv ntim nrog cov kua tshuaj lom nyob hauv tsev (ib tus neeg tuaj yeem noj tshuaj lom hauv qhov yuam kev, lossis txhob txwm ua rau qaug cawv);
- khaws cov tshuaj tua kab hauv qhov chaw nkag tau rau cov menyuam yaus (cov menyuam yaus xav paub ntau yam los ntawm qhov xwm txheej, thiab txawm tias lub thawv nrog cov tshuaj tua kab kos npe, tus menyuam me tseem tuaj yeem haus cov kua dej txaus ntshai thiab ua rau mob hnyav);
- tsis ua raws li cov cai tswj kev nyab xeeb (tsis saib xyuas cov cuab yeej tiv thaiv thaum siv cov tshuaj lom hauv tsev, xws li lub tshuab ua pa, hnab looj tes, tsom iav, tiv thaivkhaub ncaws).
Thaum cov tshuaj organophosphorus nkag mus rau tib neeg lub cev hauv cov koob tshuaj tseem ceeb, lawv tuaj yeem ua rau muaj kev puas tsuaj rau ntau qhov chaw ntawm lub paj hlwb, uas ua rau mob neuritis, tuag tes tuag taw thiab lwm yam teeb meem loj, mus txog rau kev tuag.
Kev faib tawm ntawm cov tshuaj organophosphorus los ntawm qib ntawm toxicity
- tshuaj lom ntau tshaj - tshuaj tua kab raws li thiophos, metaphos, mercaptophos, octamethyl;
- tshuaj lom heev - kev npaj raws li methylmercaptophos, phosphamide, dichlorophosphate;
- muaj tshuaj lom - chlorophos, karbofos, methylnitrophos thiab tshuaj tua kab raws li lawv, nrog rau saiphos, cyanophos, tribuphos;
- qis toxicity - demuphos, bromophos, temephos.
Cov tsos mob ntawm FOS lom
Raws li qhov hnyav ntawm cov tshuaj lom tau muab faib ua 3 theem. Lub tsev kho mob tshuaj lom organophosphate zoo li no:
Nrog rau qhov mob me me (theem I):
- psychomotor agitation thiab ntshai;
- ua tsis taus pa;
- dilated menyuam kawm ntawv (miosis);
- mob plab plab;
- nce salivation thiab ntuav;
- mob taub hau;
- ntshav siab;
- tawm hws ntau;
- ua tsis taus pa.
Rau daim ntawv nruab nrab (Stage II):
- psychomotor agitation tuaj yeem tshwm sim los yog maj mam hloov mus rau hauv lethargy, thiab qee zaum mus rau hauv coma;
- pronounced miosis, cov menyuam kawm ntawv nres lub teeb;
- cov tsos mob ntawm hyperhidrosis yog qhov tshwm sim ntau tshaj plaws (salivation (salivation), tawm hws, bronchorrhea (sputum secretion los ntawm bronchi) yog maximized);
- fibrillar twitching ntawm daim tawv muag, cov leeg hauv siab, shins, thiab qee zaum tag nrho cov leeg;
- lub sijhawm tshwm sim ntawm qhov dav dav hypertonicity ntawm cov leeg ntawm lub cev, tonic convulsions;
- lub suab ntawm lub hauv siab nce siab;
- ntshav siab peaks (250/160);
- Kev tsis quav ntsej thiab tso zis nrog kev mob tenesmus (kev xav tsis tseeb).
Kev mob hnyav heev (Stage III):
- tus neeg mob poob rau hauv qhov tob tob;
- tag nrho cov kev xav tsis muaj zog lossis tsis tuaj yeem ua tiav;
- pronounced hypoxia;
- pronounced miosis;
- khaws cia cov tsos mob ntawm hyperhidrosis;
- hloov cov leeg nqaij hypertonicity, myofibrillation thiab tonic convulsions los ntawm cov leeg tuag tes tuag taw;
- ua pa nyuaj siab, qhov tob thiab zaus ntawm kev ua pa txav tsis zoo, tuag tes tuag taw ntawm qhov chaw ua pa yog ua tau;
- lub plawv dhia mus rau theem tseem ceeb (40-20 ib feeb);
- tachycardia nce (ntau dua 120 neeg ntaus ib feeb);
- ntshav siab tseem poob;
- tshuaj lom encephalopathy txhim kho nrog edema thiab ntau diapedetic hemorrhages feem ntauhom sib xyaw, tshwm sim los ntawm kev tuag tes tuag taw ntawm cov leeg ua pa thiab kev nyuaj siab ntawm qhov chaw ua pa;
- daim tawv nqaij ua paug, cyanosis tshwm (dawb daim tawv nqaij thiab mucous daim nyias nyias ua cyanotic).
Txoj kev cuam tshuam ntawm kev lom nrog phosphorus-muaj tshuaj tua kab
Thaum cov tshuaj organophosphorus nkag mus rau hauv lub cev, kev pab thawj zaug, muab raws sijhawm thiab raug, yog ib qho tseem ceeb hauv kev txiav txim siab txog tus kabmob ntxiv. Kev kuaj mob ntawm OPC intoxication yog ib qho yooj yim los ua raws li cov yam ntxwv ntawm daim duab kho mob, tab sis txawm tias qhov txiaj ntsig zoo los yog tus neeg raug mob tuag feem ntau yog nyob ntawm cov kws kho mob tom ntej.
Vim muaj cov tshuaj toxicity siab, organophosphorus tebchaw, thaum noj, ua rau irreparable ua phem rau yuav luag tag nrho cov tseem ceeb hauv nruab nrog cev thiab tshuab. Hauv qhov no, txawm tias muaj txiaj ntsig zoo, nws tsis tuaj yeem ua kom rov qab ua haujlwm ntawm qee lub cev.
Cov teeb meem feem ntau cuam tshuam nrog kev mob hnyav ntawm organophosphorus suav nrog mob ntsws, arrhythmia thiab kev cuam tshuam ntawm kev ua haujlwm, mob qaug dab peg, thiab lwm yam.
Kev mob nkeeg
Thaum thawj ob peb hnub tom qab tshuaj lom, tus neeg mob tau mob hnyav vim mob plawv. Tom qab ntawd los ntawm kev them nyiaj maj mam thiab nws txoj kev noj qab haus huv zoo dua. Txawm li cas los xij, tom qab 2-3 lub lis piam, kev loj hlob ntawm cov mob hnyav polyneuropathy tsis suav nrog. Qee zaum, ntau lub paj hlwb tuaj yeem koom nrog.
Cov kev kawm ntawm cov kab mob polyneuropathies lig yog qhov ntev heev, qee zaum nrog kev mob tsis tu ncua. Kev kho dua tshiab ntawm cov haujlwm ntawm lub paj hlwb peripheral yog mus tsis zoo. Tej zaum kuj yuav muaj qhov rov tshwm sim ntawm cov mob hnyav xws li cholinergic crises. Qhov no tau piav qhia los ntawm qhov tseeb tias cov khoom siv organophosphorus tso tawm yog "tshem tawm" los ntawm ntau cov ntaub so ntswg mus rau hauv lub cev.
Kev kho mob
Thaum muaj mob organophosphorus loj tshwm sim, kev pab thawj zaug yuav tsum suav nrog kev ua kom huv ntawm lub plab zom mov los ntawm plab hnyuv nrog lub raj, yuam diuresis, thiab lwm yam., tswj kev ua pa, thiab tswj cov tshuaj tiv thaiv tshwj xeeb. Tsis tas li ntawd, cov txheej txheem ntawm kev ua kom rov muaj sia nyob tau siv, suav nrog kev kho tshuaj, txhawm rau tswj thiab kho lub cev puas tsuaj, suav nrog kev ntsuas los kho lub plawv dhia, kho homeostasis mob thiab exotoxic shock.
Restoration of respiratory function
Organophosphorus tebchaw uas noj ntau ntau feem ntau ua rau muaj kev nyuaj siab ua pa los ntawm ntau dhau ntawm oropharyngeal secretion, bronchospasm thiab tuag tes tuag taw ntawm cov leeg ua pa. Hauv qhov no, thawj qhov uas cov kws kho mob sim ua yog rov ua kom lub ntsws patency thiab ua kom muaj cua txaus. Nyob rau hauv lub xub ntiag ntawm ntau ntuav thiab oropharyngeal tawm, aspiration yog siv (kua sampling siv lub nqus tsev vacuum). NtawmMob OPC lom, resuscitation muaj xws li tracheal intubation, dag lub ntsws ua pa.
tshuaj tiv thaiv kab mob
Kev siv tshuaj tua kab mob (antidotes) yog ib feem tseem ceeb ntawm kev kho mob thaum muaj xwm ceev rau kev mob lom. Cov tshuaj ntawm pab pawg no cuam tshuam rau kinetics ntawm cov tshuaj lom hauv lub cev, xyuas kom nws nqus los yog tshem tawm, txo cov nyhuv co toxins ntawm receptors, tiv thaiv cov metabolism txaus ntshai thiab tshem tawm cov teeb meem txaus ntshai ntawm lub luag haujlwm tseem ceeb ntawm lub cev los ntawm kev lom.
Cov tshuaj tiv thaiv kab mob organophosphorus lom yog noj nrog rau lwm cov tshuaj tshwj xeeb. Pharmacotherapy yog ua nyob rau tib lub sijhawm nrog kev kho kom rov zoo thiab tshem tawm cov tshuaj tua kab mob.
Nws yuav tsum nco ntsoov tias yog tias tsis muaj qhov ua tau sai sai, tsuas yog tshuaj tua kab mob ntawm cov tshuaj organophosphorus tuaj yeem cawm tus neeg raug tsim txom txoj sia, thiab qhov tshuaj sai dua, tus neeg raug tsim txom yuav muaj txiaj ntsig zoo. qhov tshwm sim ntawm tus kab mob.
Kev faib tawm ntawm cov tshuaj tiv thaiv
Tshuaj tua kab mob tau muab faib ua plaub pawg:
- symptomatic (pharmacological);
- Ybiochemical (toxicokinetic);
- tshuaj (toxicotropic);
- tshuaj tiv thaiv kab mob tiv thaiv kab mob.
Thaum thawj cov tsos mob ntawm organophosphate lom tshwm sim, txawm tias nyob rau theem ntawm kev mus pw hauv tsev kho mob ntawm tus neeg raug tsim txom, tshuaj tua kab mob ntawm cov tsos mob thiab toxicotropic pawg tau siv, vim lawv muaj cov lus qhia meej rausiv. Cov tshuaj uas muaj cov tshuaj toxicokinetic yuav tsum tau ua raws li cov lus qhia nruj me ntsis, txij li cov kws kho mob xwm txheej ceev tsis tuaj yeem txiav txim siab qhov tseeb rau lawv siv. Antitoxic immunodrugs yog siv nyob rau hauv ib lub tsev kho mob.
Kev kho tshwj xeeb rau mob organophosphate lom
Ib txheej ntawm kev ntsuas suav nrog kev siv tshuaj anticholinergics (tshuaj xws li atropine) ua ke nrog cholinesterase reactivators. Hauv thawj teev tom qab tus neeg mob mus pw hauv tsev kho mob, mob atropinization yog nqa tawm. Atropine nyob rau hauv cov koob tshuaj loj yog muab tso rau hauv cov hlab ntsha kom txog thaum cov tsos mob ntawm hyperhidrosis tau txo qis. Tseem yuav tsum muaj cov cim qhia ntawm kev noj tshuaj me me ntawm cov tshuaj, qhia los ntawm cov tawv nqaij qhuav thiab nruab nrab tachycardia.
Txhawm rau tswj hwm lub xeev no, atropine tau siv ntau zaus, tab sis hauv koob me me. Kev txhawb nqa atropinization ua rau muaj kev cuam tshuam tsis tu ncua ntawm cov kab ke m-cholinergic ntawm cov kab mob puas tsuaj tiv thaiv kev ua ntawm cov tshuaj acetylcholine rau lub sijhawm xav tau rau kev puas tsuaj thiab tshem tawm cov co toxins.
Ntawm cholinesterase reactivators muaj peev xwm ua kom cov cholinesterase inhibited thiab neutralize ntau yam phosphorus-muaj cov tebchaw. Thaum lub sijhawm kho tshwj xeeb, kev ua haujlwm cholinesterase tau saib xyuas tas li.
