消化内科课件 白双语中毒 .pptVIP

Acute organic phosphorus insecticides poisoning 急性有机磷杀虫药中毒 Overview OPI belong 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. 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：LD50 10~100mg/kg methyl parathion, methamidophos, dichlorvos/甲基对硫磷、甲胺磷、敌敌畏 moderate poison /中毒类：LD50 100~1000mg/kg dimethoate, trichlorfon/乐果、敌百虫 low poison /低毒类：LD50 1000~5000mg/kg mara sulphur phosphorous /马拉硫磷 Category Etiology Occupational poisoning Production, using Living poisoning Etiology Mechanism Toxic absorption, metabolism and discharge 毒物的吸收、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 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 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 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