中毒中英文版培訓課件

1、中毒中英文版OverviewOPI belong to organophosphate/有機磷酸酯or dithio phosphate ester/硫代磷酸酯類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/乙酰膽堿酯酶inhibition ,cause the accumulation

2、 of acetylcholine/乙酰膽堿.2中毒中英文版rank poison /劇毒類：LD5010mg/kgphorate, phosphorus absorption and parathion /甲拌磷、內吸磷、對硫磷 high poison /高毒類：LD50 10100mg/kgmethyl parathion, methamidophos, dichlorvos/甲基對硫磷、甲胺磷、敵敵畏 moderate poison /中毒類：LD50 1001000mg/kgdimethoate, trichlorfon/樂果、敵百蟲 low poison /低毒類：LD50 1000

3、5000mg/kgmara sulphur phosphorous /馬拉硫磷Category3中毒中英文版Etiology Occupational poisoning Production, using Living poisoningEtiology & Mechanism4中毒中英文版Toxic absorption, metabolism and discharge毒物的吸收、代謝與排出OPIBodyLiverOxidationDeductionHydrolysisConjugationDischarge via kidneyGI tract, Respiratory tractSk

4、in, etc.BloodRespiratory tractGI tractSkinMucosaBiotransformation5中毒中英文版Mechanism/發(fā)病機制True cholinesterase /真性膽堿酯酶：CNS Gray matter 、RBC、sympathetic ganglion end plate movement /CNS灰質、RBC、交感神經(jīng)節(jié)、運動終板Pseudo cholinesterase/假性膽堿酯酶（丁酰膽堿酯酶）：CNS white matter, serum, liver and intestinal submucosa /CNS白質、血清、肝

5、、腸黏膜下層 水 解正常生理狀態(tài)下：乙酰膽堿 乙酸 + 膽堿 膽堿酯酶 6中毒中英文版 Organophosphorus+cholinesterase/有機磷膽堿酯酶 Phosphorus acylation cholinesterase / 磷?；憠A酯酶 Inhibit cholinesterase /抑制膽堿酯酶Acetylcholine decomposition /乙酰膽堿分解Acetylcholine accumulation /乙酰膽堿堆積Cholinergic nerve disorder/膽堿能神經(jīng)紊亂7中毒中英文版 1.Muscarinic signs/毒蕈堿（M)樣癥狀：

6、Glands secretion increase, smooth muscle contraction, sphincter relaxation,performance:/腺體分泌增加,平滑肌收縮,括約肌松弛 （1）Sweating, salivate, tears, runny nose, lung bubble, shortness of breath, difficulty breathing /多汗,流涎,流淚,流涕, 肺部濕羅音,氣促,呼吸困難 （ 2）Miosis, nausea, vomiting, abdominal pain, diarrhea /瞳孔縮小,惡心,嘔吐,腹

7、痛,腹瀉 （3） Urinary and fecal incontinence /尿、便失禁 Clinical manifestation(一)Acute cholinergic crisis/急性膽堿能危象8中毒中英文版 2.Nicotinic signs/煙堿（N）樣癥狀：The sympathetic nervous excitement,adrenal medulla secretion /交感神經(jīng)興奮，腎上腺髓質分泌。 High blood pressure, cardiac arrhythmia/血壓高，心律失常 Skeletal muscle nerve-Muscle joint

8、 block,characterized by muscle tremors and muscle weakness, respiratory myoparalysis, lead to respiratory failure /骨骼肌神經(jīng)-肌肉接頭阻斷 ，表現(xiàn)為肌顫,肌無力，呼吸肌麻痹，導致呼吸衰竭。Clinical manifestation9中毒中英文版 3.CNS symptoms dizziness, headaches, mood swings ;severe person convulsions or coma. Serious breathing, circulation ce

9、ntral inhibition and death /輕者頭暈，頭痛，情緒不穩(wěn)；重者抽搐昏迷， 嚴重者呼吸、循環(huán) 中樞抑制而死亡。Clinical manifestation10中毒中英文版 4.Local lesion sensitization dermatitis/過敏性皮炎，exfoliative dermatitis/剝脫性皮炎11中毒中英文版（三）Intermediate syndrome/中間型綜合征Occur within 24-96 h after poisoning,between the cholinergic crisis and late-onset neuropa

10、thy / 發(fā)生于中毒后24-96h，在膽堿能危象和遲發(fā)性神經(jīng)病之間。Clinical manifestation13中毒中英文版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 mastica

11、tory muscle weakness, voice hoarse, difficulty swallowing and breathing myoparalysis /屈頸肌，肢體近端肌，顱神經(jīng)、支配的肌肉無力，重者累及呼吸肌。表現(xiàn)：抬頭困難，眼瞼下垂，睜眼困難，咀嚼肌無力，聲音嘶啞，吞咽困難，呼吸肌麻痹 Mechanism:cholinesterase affected by long-term suppression,impact the nerve - muscle postsynaptic joint function . /膽堿酯酶受到長期抑制，影響神經(jīng)肌肉接頭處突觸后功能14中

12、毒中英文版Determination of blood cholinesterase activity/膽堿酯酶活力測定 Normal choline enzyme activity value of 100% Mild 70-50% Moderate 50-30% Severe 30% Urinary metabolite determination of organic phosphorusLaboratory examination15中毒中英文版 History of exposure to organophosphorus pesticides Typical clinical ma

13、nifestations Laboratory test ：ChE, urinary metabolite Diagnosis16中毒中英文版 Mild poisoning, muscarinic signs, ChE fell to 70-50% of normal /毒蕈堿樣癥狀Moderate poisoning, muscarinic signs +nicotine signs , ChE down to about 50-30% of normal./毒蕈堿煙堿樣癥狀 Severe poisoning, in addition to the above signs ,have com

14、a, pulmonary edema and cerebral edema, ChE dropped to below 30% of normal. /昏迷、肺水腫、腦水腫 Degree classification17中毒中英文版TreatmentCleaning the poisoningTake away from the scene Cleaning the skin， hair and nails Gastric lavage：Trichlorfon avoid alkaline drugs /敵百蟲忌堿性藥，Parathion avoid potassium permanganat

15、e /對硫磷忌高錳酸鉀 Catharsis18中毒中英文版Emergency recovery/緊急復蘇Pneumonedema, respiratory muscle paralysis, respiratory failure ，cardiac arrest/肺水腫，呼吸肌麻痹，呼吸衰竭，心臟驟停19中毒中英文版 Antidote/解毒藥Principles：use antidotes as soon as possible, in sufficient quantities, coadunation and repeat.Cholinesterase reactivator/膽堿酯酶復活

16、劑：Oxime compounds,remove nicotine toxic effects /肟類化合物，解除煙堿樣毒性作用.pralidoxime chloride, pralidoxime iodide obidoxime Chloride/氯解磷定、碘解磷定、雙復磷20中毒中英文版Cholinoceptor blocking drugs/膽堿受體拮抗藥（1）M cholinergic antagonistsatropine，anisodamine/山莨菪堿 Alleviate muscarinic symptoms and against respiratory central in

17、hibition /緩解毒蕈堿樣癥狀和對抗呼吸中樞抑制Principles: Atropine，gradually reduced，to maintain the dosage 阿托品化、逐漸減量、維持用量21中毒中英文版difference between atropine and atropine poisoningAtropine: pupil dilation, dry mouth, dry skin, fast heart rate increases, lung wet rale disappearing./阿托品化：瞳孔擴大、口干、皮膚干燥、心率增快、肺部濕羅音消失。 Atrop

18、ine poisoning: pupils significantly expanded, consciousness, dysphoria, convulsions, coma, urinary retention. /阿托品中毒：瞳孔明顯擴大、神志模糊、煩躁不安、抽搐、昏迷、尿潴留。22中毒中英文版（2）N cholinergic antagonists -scopolamine /東莨菪堿Effect center M and N acceptor，alleviate muscarinic symptoms Mild poisoning: cholinesterase reactivatorSevere poisoning: cholinesterase reactivator+ cholinoceptor blocking drugs23中