Organophosphates: daim ntawv thov, cov kauj ruam thiab nta hauv paus ntsiab lus. Organophosphate lom, thawj pab

Organophosphates yog tshuaj pawg, uas yog tsim los tua nroj, cov kab thiab tsuag.

Cov tshuaj tua kab yog lug siv tsis tau tsuas yog nyob rau hauv ua liaj ua teb tab sis kuj nyob rau hauv lub neej txhua hnub. Muaj ntau ntau ntau yam ntawm FOS no mas lom thiab yuav ua rau loj lom los ntawm haus ntawm ob sab hauv lub cev thiab nyob rau hauv kev sib cuag nrog lub qhov ntswg mucosa thiab qhov muag, thiab txawm nrog lub lawm daim tawv nqaij.

Txheeb cais FOS lom

Mob intoxication los ntawm organophosphorus tebchaw nyob rau hauv qhov tseeb yuav siv sij hawm hauv thawj qhov chaw ntawm lwm cov exogenous lom tsis tau tsuas yog lub ntiajteb txawj nqus tab sis kuj los ntawm zaus. Lethality xws lom yog ze li ntawm 20%, thaum lub zaus ntawm - txog 15% ntawm txhua tus neeg mob intoxication. Ntawm kev txaus siab yog qhov tseeb hais tias lub peculiar antidote rau organophosphate lom yog haus dej cawv. Nyob rau hauv cov neeg mob uas twb nyob rau hauv ib lub xeev ntawm huab intoxication thaum lub sij hawm ntawm lom nrog tshuaj tua kab, cov kab mob no yog yooj yim npaum li (convulsions thiab paresis ntawm lub pa nqaij yog tsis muaj). Txawm li cas los, hemodynamic mob tej zaum yuav ntau pronounced.

Tau ua ntawm kev qaug tshuaj lom nrog tshuaj tua kab

Organophosphate lom tej zaum yuav vim ua hauj lwm thiab tshwm sim vim kev tuav ntawm tej yam tshuaj lom. Negligence ntawm ib tug los yog ntau tshaj cov neeg tej zaum yuav raug nyob rau hauv tsis yog ib tug loj lom rau lawv tus kheej, tab sis kuj ua rau loj intoxication.

Nyob rau hauv tas li ntawd mus no, cov tshuaj lom los ntawm organophosphorus tebchaw yuav tau npog txhua hnub xwm. Cov ua ntawm cov xwm txheej yuav tau sib txawv, piv txwv li:

• tsis muaj tej yam tshwm sim nyob rau hauv ntim nrog lom kua, muab cia rau hauv lub tsev (tus neeg muaj peev xwm coj cov tshuaj lom hauv los ntawm yuam kev los yog txhob txwm rau lub hom phiaj ntawm intoxication);
• cia ntawm tshuaj tua kab nyob rau hauv lub ncav cuag ntawm cov me nyuam (cov me nyuam los ntawm qhov yog mas, thiab txawm hais tias ib lub taub ntim ntawm tshuaj lom tshuaj yuav tsum kos npe rau, ib tug me nyuam me me muaj peev xwm tseem haus ib tej kua thiab tau mob lom);
• tsis ua hauj lwm ua raws li kev ruaj ntseg cov kev cai (tsis saib xyuas txhais tau tias kev tiv thaiv thaum siv nyob rau hauv tsev neeg tej yam tshuaj lom, xws li tej hmoov av npog qhov ncauj, hnab looj tes, tsom iav, khaub ncaws tiv thaiv).

Thaum lub organophosphorus compound nyob rau hauv loj koob tshuaj poob rau tib neeg lub cev, lawv muaj peev xwm ua rau txhab ntawm ntau qhov chaw ntawm lub hauv paus poob siab system uas ua rau yus neuritis, tuag tes tuag taw thiab lwm yam txim, xws li kev tuag.

Ib suam ntawm organophosphorus tebchaw rau lub toxicity

• lub feem ntau lom - raws li tshuaj tua kab thiophos, Metaphos, merkaptofosa, octamethyl;
• tshuaj lom - tshuaj raws li demeton-s-methyl, phosphamide, dichlorophosphate;
• srednetoksichnye - trichlorfon, malathion, metilnitrofos thiab tshuaj tua kab raws li nyob rau hauv lawv, raws li tau zoo raws li sayfos, cyanophos, tribufos;
• tsawg-toxicity - demufos, bromophos, temephos.

Cov tsos mob ntawm lom FOS

Raws li cov neeg kawm ntawv ntawm kev qaug tshuaj lom ntawm lub ntiajteb txawj nqus raug muab faib ua 3 theem. Clinic organophosphate lom yog raws li nram no:

Me me intoxication (kuv theem):

• psychomotor ntxhov siab thiab kev xav ntawm txoj kev ntshai;
• ua tsis taus pa;
• dilated cov menyuam kawm ntawv (miosis);
• spastic mob nyob rau hauv lub plab mog;
• nce salivation thiab ntuav;
• mob loj heev mob taub hau;
• ntshav siab;
• profuse tawm hws;
• hawb pob.

Thaum mob loj tsawv daim ntawv (II theem):

• ntxhov siab yuav khaws cia los yog maj mam hloov inhibition, thiab tej zaum - thiab coma;
• ntaus cim miosis, tus menyuam kawm ntawv mus rau lub teeb tsis teb;
• maximally qhia cov tsos mob ntawm hyperhidrosis (maximized salivation (qaub ncaug), tawm hws, bronhoreya (phlegm los ntawm bronchi));
• fibrillar laim muag daj, nqaij ntshiv ntawm lub hauv siab, ob txhais ceg, thiab tej zaum kuj tag nrho rau cov nqaij ntshiv;
• periodic tsos ntawm cus tag nrho lub cev nqaij, tonic convulsions;
• dramatically tsub kom lub suab nrov ntawm lub hauv siab;
• ntshav siab nce mus txog ib tug tshaj plaws kev kawm (250/160);
• tsis tuaj yeem defecation thiab tso zis, nrog mob tenesmus (cuav siab nyiam).

Loj lom (III theem):

• tus neeg mob ntog mus rau hauv ib tug sib sib zog nqus coma;
• Tag nrho cov reflexes yog tsis muaj zog txaus los yog tsis tuaj kiag li;
• mob loj heev hypoxia;
• cov lus hais miosis;
• preservation ntawm hyperhidrosis cov tsos mob;
• kev hloov ntawm npag hypertonus, miofibrillyatsii thiab tonic convulsions ua ib ce tuag nqaij so;
• xav muaj kev nyuaj siab ua pa tob thiab zaus ntawm cov pa yog lus, nws yog ua tau pa tuag tes tuag taw;
• lub plawv dhia yog lowered mus rau lub tseem ceeb heev ntsuas (40-20 min.);
• tachycardia enhanced (ntau tshaj 120 neeg ntaus ib min.);
• ntshav siab tseem poob;
• tsim tshuaj lom encephalopathy nrog edema thiab hemorrhages heev heev diapedetic dua mixed hom, vim tuag tes tuag taw ntawm lub pa nqaij thiab inhibition ntawm cov pa center;
• daim tawv nqaij dheev ploj tshwm cyanosis (daim tawv nqaij thiab qog ua kua week ua xiavlus xim).

Lub txim ntawm kev qaug tshuaj lom phosphorus tshuaj tua kab

Thaum lub cev poob organophosphorus tebchaw, thawj pab mus kom sai thiab kom zoo, yog ib tug ntawm cov yuav tsum muaj yam tseem ceeb uas txiav txim seb lub ntxiv rau thaum kawg ntawm tus kab mob no. FOS intoxication mob yog tus yooj yim kom muab tso rau cov yam ntxwv soj ntsuam daim duab, li cas los xij, yog hais tias lub sij hawm ntawm lub paaj los yog tus neeg tuag, nyob lom zem ntau nyob rau hauv qab-up kev kho mob.

Vim lub high toxicity ntawm organophosphorus tebchaw thaum noj ua irreparable raug mob yuav luag tag nrho cov tseem ceeb heev nruab nrog cev thiab tshuab. Nyob rau hauv no kev twb kev txuas, txawm tias ib tug paaj sij hawm rau tag nrho rov qab kho cov nuj nqi ntawm tej yam kabmob uas yuav tsis.

Ntawm cov teeb meem, uas yog feem ntau nrog rau mob hnyav qaug cawv los ntawm organophosphorus tebchaw xws li mob ntsws, mob arrhythmias thiab mob conduction, tshuaj hob psychosis nyob rau hauv lub mob hauv daim ntawv, thiab lwm yam

tus kab mob no

Thaum lub sij hawm thawj ob peb hnub tom qab lub lom, tus neeg mob yog nyob rau hauv ib tug loj mob tshwm sim los ntawm cov hlab plawv tus cev qhuav dej. Ces los ib gradual nyiaj thiab pab txoj kev noj qab haus huv. Txawm li cas los, tom qab 2-3 lub lim piam, nws yog tau txoj kev loj hlob mob tshuaj lom polyneuropathy. Nyob rau hauv tej rooj plaub, cov txheej txheem yuav tsum muab kev koom tes ib tug xov tooj ntawm cranial qab haus huv.

Thaum lub sij hawm no tom qab polyneuropathy sufficiently heev, tej zaum kuj nrog pheej zog ntshawv siab. Restore zog ntawm cov peripheral lub paj hlwb yog phem. Nws kuj tshwm sim rov qab los ntawm mob mob, xws li cholinergic ntsoog. Yog vim li cas yog tias tso organophosphorus compound "ntiab tawm" los ntawm ntau yam ntaub so ntswg mus rau hauv lub plawv system.

kev kho mob

Thaum cov ntaub ntawv ntawm loj lom los ntawm organophosphorus tebchaw, thawj pab yuav tsum muaj xws li txhoj puab heev tu ntawm lub digestive ib ntsuj av tau los ntawm pais plab lavage siv ib tug kev sojntsuam yuam diuresis, etc., txij nkawm ntawm kev ua pa thiab kev siv ntawm tej Antidotes. Ntxiv mus, ib tug complex ntawm resuscitation, xws li pharmacotherapy, aimed ntawm kev tswj thiab es puas cev functions, nrog rau kev ntsuas los mob kev ua si, kev kho mob ntawm kev mob ntawm homeostasis thiab exotoxic poob siab.

Txum Tim Rov Qab pa muaj nuj nqi

Organophosphorus tebchaw daig nyob rau hauv lub cev nyob rau hauv loj qhov ntau, feem ntau yog ua rau ua pa nyuaj siab, tshwm sim los ntawm ntau ntau oropharyngeal secretion, thiab bronchoconstriction tuag tes tuag taw ntawm ua pa nqaij. Nyob rau hauv kev twb kev txuas nrog rau qhov no, thawj qhov uas cov kws kho mob tseem tabtom ua - yog los caj pas thiab xyuas kom meej txaus cua. Nyob rau hauv lub xub ntiag ntawm ntau vomitus thiab oropharyngeal paug, siv aspiration (kom tsawg ntawm cov kua los ntawm lub tshuab nqus tsev). Nyob rau hauv mob lom FOS resuscitation xws li endotracheal intubation, neeg kho tshuab cua.

antidote txoj kev kho

Daim ntawv thov safeners (Antidotes) yog ib feem tseem ceeb ntawm thaum muaj xwm ceev pharmacotherapy nyob rau hauv mob lom. Tshuaj nyob rau hauv pab pawg neeg no muaj feem xyuam rau lub kinetics nyob rau hauv lub cev ntawm tej yam tshuaj lom, muab nws cov haum los sis tshem tawm, txo nyhuv on taug receptors tiv thaiv yus metabolize thiab tshem tawm tej kev ntshawv siab uas tseem ceeb heev lub cev functions, tshwm sim los ntawm intoxication.

Antidote rau lom los ntawm organophosphorus tebchaw noj ua ke nrog rau lwm cov tshwj xeeb cov tshuaj. Pharmacotherapy yog muaj nyob rau hauv thaum uas tig mus nrog tus resuscitation thiab detoxifying kho ntsuas.

Nws yuav tsum tau nco ntsoov hais tias hais tias muaj yog tsis muaj tau tam sim ntawd resuscitation, tus neeg lub neej yuav raug cawm dim tau tsuas antidote organophosphorus tebchaw, thiab cov ua ntej nws yog tswvcuab, qhov zoo lub caij nyoog rau tus neeg yuav tsum muaj ib tug paaj sij hawm ntawm tus kab mob.

kev faib ntawm Antidotes

Antidotes yog txwv kom muab zais rau hauv cov plaub pawg:

• symptomatic (pharmacological);
• biochemical (toxicokinetic);
• tshuaj (toksikotropnye);
• antitoxic Immunopreparat.

Thaum tus thawj cov tsos mob ntawm organophosphate lom, tsis tau nyob rau hauv kauj ruam dogospitalizatsii raug tsim txom, thiab siv cov tshuaj symptomatic toksikotropnoy pawg, txij li thaum lawv muaj ib tug meej hais rau cov kev siv. Npaj toxicokinetic txiav txim yuav tsum tau nruj kev ua raws li cov lus qhia, vim hais tias cov tsheb thauj neeg mob cov kws kho mob yuav tsis yeej ib txwm meej txiav txim seb tus indications rau lawv siv. Antitoxic Immunopreparat siv nyob rau hauv ib tug lub tsev kho mob.

Kev kho nyob rau hauv mob lom los ntawm organophosphorus tebchaw

Complex txheej xwm comprises siv anticholinergics (atropine hom tshuaj) nyob rau hauv ua ke nrog nrog ib tug cholinesterase reactivator. Nyob rau hauv thawj teev tom qab pw tsev kho mob ua intensive atropine. Atropine nyob rau hauv loj koob tshuaj yog muab intravenously mus rau lub nyem ntawm cov tsos mob ntawm hyperhidrosis muaj. Yuav tsum kuj yuav tshwm sim ntawm tsis muaj zog tshuaj overdose, qhia qhuav tawv nqaij thiab moderate tachycardia.

Kom muaj lub xeev no ntawm atropine yog xeem dua, tab sis nyob rau hauv me me koob tshuaj. Supportive atropinization tsim ib tug pheej blockade ntawm m-cholinoreactive systems puas lub cev los tiv thaiv-tshuaj kev txiav txim ntawm acetylcholine rau lub sij hawm yuav tsum tau rau txoj kev puas tsuaj thiab tshem tawm ntawm toxins.

Niaj hnub nimno Reaktivatory cholinesterase tau zoo ua ntu oppressed cholinesterase thiab neutralize ntau yam phosphorus tebchaw. Nyob rau hauv nqa tawm kev kho yog raug soj qab lossi cholinesterase kev ua si.