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NEJM：有机磷中毒为啥出现舌肌震颤-案例报道

2016-12-08 xing.T MedSci原创

有机磷中毒舌肌震颤
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有机磷农药抑制胆碱酯酶，使乙酰胆碱积聚作用于神经系统中的多种受体。肌震颤是因为神经肌肉接头处的乙酰胆碱受体过度刺激所导致。


患者为15岁男孩，与他的家人一起居住在农场，因呕吐、腹泻、感觉改变一天而就诊于急诊。 

在初步评估中，他昏昏欲睡，出现呼吸急促和低血压。肺部的听诊显示弥漫性捻发音。该患者瞳孔反应良好，两侧大小相同，轻度狭窄（直径为4毫米）。没有局灶性神经功能缺损。在插入进食管过程中，该患者出现明显的弥散性舌肌束震颤。进一步的检查发现，患者轻度贫血，白细胞计数升高，血浆胆碱酯酶水平降低。胆碱能症状，舌肌束震颤和家里的农业背景提示诊断为有机磷中毒。 

病人用阿托品、静脉输液和正性肌力药物治疗。阿托品给药48小时，待临床症状改善和消除后逐渐减少。患者陈述其服用了杀虫剂溶液（含2,2-二氯乙烯基磷酸二甲酯），因在学校表现不佳试图自杀。 

有机磷农药抑制胆碱酯酶，使乙酰胆碱积聚作用于神经系统中的多种受体。肌震颤是因为神经肌肉接头处的乙酰胆碱受体过度刺激所导致。 

原始出处： 

Bharath A. Chhabria,et al. Tongue Fasciculations in Organophosphate Poisoning.N Engl J Med 2016; 375:e47December 8, 2016DOI: 10.1056/NEJMicm1605077 

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  1. [GetPortalCommentsPageByObjectIdResponse(id=173667, encodeId=64ec1e36679f, content=这个也能发？, beContent=null, objectType=article, channel=null, level=null, likeNumber=112, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7b6f1959148, createdName=梦想无极限, createdTime=Wed Feb 01 22:14:24 CST 2017, time=2017-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1319025, encodeId=6faa1319025fc, content=<a href='/topic/show?id=14d92231508' target=_blank style='color:#2F92EE;'>#中毒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22315, encryptionId=14d92231508, topicName=中毒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f13d475, createdName=mashirong, createdTime=Fri Dec 09 22:43:00 CST 2016, time=2016-12-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1490119, encodeId=c0101490119de, content=<a href='/topic/show?id=41d698891ef' target=_blank style='color:#2F92EE;'>#震颤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98891, encryptionId=41d698891ef, topicName=震颤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=59428697908, createdName=kalseyzl, createdTime=Fri Dec 09 22:43:00 CST 2016, time=2016-12-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=161211, encodeId=849816121109, content=这也能发, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=73801651090, createdName=1ddc978cm67(暂无匿称), createdTime=Thu Dec 08 14:53:56 CST 2016, time=2016-12-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=161186, encodeId=caa3161186b6, content=这是那个国家的？对中国基层医生来说这根本就不算个事。, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=61e51518453, createdName=wqw6365, createdTime=Thu Dec 08 12:48:56 CST 2016, time=2016-12-08, status=1, ipAttribution=)]
    2017-02-01 梦想无极限

    这个也能发？

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=173667, encodeId=64ec1e36679f, content=这个也能发？, beContent=null, objectType=article, channel=null, level=null, likeNumber=112, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7b6f1959148, createdName=梦想无极限, createdTime=Wed Feb 01 22:14:24 CST 2017, time=2017-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1319025, encodeId=6faa1319025fc, content=<a href='/topic/show?id=14d92231508' target=_blank style='color:#2F92EE;'>#中毒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22315, encryptionId=14d92231508, topicName=中毒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f13d475, createdName=mashirong, createdTime=Fri Dec 09 22:43:00 CST 2016, time=2016-12-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1490119, encodeId=c0101490119de, content=<a href='/topic/show?id=41d698891ef' target=_blank style='color:#2F92EE;'>#震颤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98891, encryptionId=41d698891ef, topicName=震颤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=59428697908, createdName=kalseyzl, createdTime=Fri Dec 09 22:43:00 CST 2016, time=2016-12-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=161211, encodeId=849816121109, content=这也能发, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=73801651090, createdName=1ddc978cm67(暂无匿称), createdTime=Thu Dec 08 14:53:56 CST 2016, time=2016-12-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=161186, encodeId=caa3161186b6, content=这是那个国家的？对中国基层医生来说这根本就不算个事。, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=61e51518453, createdName=wqw6365, createdTime=Thu Dec 08 12:48:56 CST 2016, time=2016-12-08, status=1, ipAttribution=)]
    2016-12-09 mashirong

    #中毒#

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=173667, encodeId=64ec1e36679f, content=这个也能发？, beContent=null, objectType=article, channel=null, level=null, likeNumber=112, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7b6f1959148, createdName=梦想无极限, createdTime=Wed Feb 01 22:14:24 CST 2017, time=2017-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1319025, encodeId=6faa1319025fc, content=<a href='/topic/show?id=14d92231508' target=_blank style='color:#2F92EE;'>#中毒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22315, encryptionId=14d92231508, topicName=中毒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f13d475, createdName=mashirong, createdTime=Fri Dec 09 22:43:00 CST 2016, time=2016-12-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1490119, encodeId=c0101490119de, content=<a href='/topic/show?id=41d698891ef' target=_blank style='color:#2F92EE;'>#震颤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98891, encryptionId=41d698891ef, topicName=震颤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=59428697908, createdName=kalseyzl, createdTime=Fri Dec 09 22:43:00 CST 2016, time=2016-12-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=161211, encodeId=849816121109, content=这也能发, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=73801651090, createdName=1ddc978cm67(暂无匿称), createdTime=Thu Dec 08 14:53:56 CST 2016, time=2016-12-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=161186, encodeId=caa3161186b6, content=这是那个国家的？对中国基层医生来说这根本就不算个事。, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=61e51518453, createdName=wqw6365, createdTime=Thu Dec 08 12:48:56 CST 2016, time=2016-12-08, status=1, ipAttribution=)]
    2016-12-09 kalseyzl

    #震颤#

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=173667, encodeId=64ec1e36679f, content=这个也能发？, beContent=null, objectType=article, channel=null, level=null, likeNumber=112, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7b6f1959148, createdName=梦想无极限, createdTime=Wed Feb 01 22:14:24 CST 2017, time=2017-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1319025, encodeId=6faa1319025fc, content=<a href='/topic/show?id=14d92231508' target=_blank style='color:#2F92EE;'>#中毒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22315, encryptionId=14d92231508, topicName=中毒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f13d475, createdName=mashirong, createdTime=Fri Dec 09 22:43:00 CST 2016, time=2016-12-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1490119, encodeId=c0101490119de, content=<a href='/topic/show?id=41d698891ef' target=_blank style='color:#2F92EE;'>#震颤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98891, encryptionId=41d698891ef, topicName=震颤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=59428697908, createdName=kalseyzl, createdTime=Fri Dec 09 22:43:00 CST 2016, time=2016-12-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=161211, encodeId=849816121109, content=这也能发, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=73801651090, createdName=1ddc978cm67(暂无匿称), createdTime=Thu Dec 08 14:53:56 CST 2016, time=2016-12-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=161186, encodeId=caa3161186b6, content=这是那个国家的？对中国基层医生来说这根本就不算个事。, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=61e51518453, createdName=wqw6365, createdTime=Thu Dec 08 12:48:56 CST 2016, time=2016-12-08, status=1, ipAttribution=)]
    2016-12-08 1ddc978cm67(暂无匿称)

    这也能发

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=173667, encodeId=64ec1e36679f, content=这个也能发？, beContent=null, objectType=article, channel=null, level=null, likeNumber=112, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7b6f1959148, createdName=梦想无极限, createdTime=Wed Feb 01 22:14:24 CST 2017, time=2017-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1319025, encodeId=6faa1319025fc, content=<a href='/topic/show?id=14d92231508' target=_blank style='color:#2F92EE;'>#中毒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22315, encryptionId=14d92231508, topicName=中毒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f13d475, createdName=mashirong, createdTime=Fri Dec 09 22:43:00 CST 2016, time=2016-12-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1490119, encodeId=c0101490119de, content=<a href='/topic/show?id=41d698891ef' target=_blank style='color:#2F92EE;'>#震颤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98891, encryptionId=41d698891ef, topicName=震颤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=59428697908, createdName=kalseyzl, createdTime=Fri Dec 09 22:43:00 CST 2016, time=2016-12-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=161211, encodeId=849816121109, content=这也能发, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=73801651090, createdName=1ddc978cm67(暂无匿称), createdTime=Thu Dec 08 14:53:56 CST 2016, time=2016-12-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=161186, encodeId=caa3161186b6, content=这是那个国家的？对中国基层医生来说这根本就不算个事。, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=61e51518453, createdName=wqw6365, createdTime=Thu Dec 08 12:48:56 CST 2016, time=2016-12-08, status=1, ipAttribution=)]
    2016-12-08 wqw6365

    这是那个国家的？对中国基层医生来说这根本就不算个事。

    0

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