Effects of Standard Treatment Alone Versus Standard Treatment plus Plasmapheresis on the Levels of Serum Pseudocholinesterase and Erythrocyte Acetylcholinesterase in Critically Patients with Organophosphate Poisoning: Randomized Controlled, Open-label, Clinical Trial

Öz

Objective: Organophosphates are the insecticides commonly used worldwide. Inadequate treatment in organophosphates poisoning increases morbidity, and mortality. Purpose of the work was to determine the effect of standard treatment alone versus standard treatment plus plasmapheresis on the levels of serum pseudo-cholinesterase, and erythrocyte acetyl cholinesterase in severe patients with organophosphates poisoning. Material and Method: This research is a prospective study. Patients diagnosed with organophosphates poisoning were included in the work. The patients were divided into two groups as the intervention group, and the standard group. The intervention group, plasmapheresis was performed in addition to the standard treatment. Results: The research was conducted with forty cases. (Intervention group n:21, standard group n:19). Serum pseudo-cholinesterase values were 482.5 u/L at baseline, 3723 u/L after plasmapheresis. Erythrocyte acetyl cholinesterase values were 1.91 u/mL on admission, 2.53 u/mL after plasmapheresis. Erythrocyte acetyl cholinesterase and serum pseudo-cholinesterase values were compared between the two groups daily from the admission of patients to intensive care units during the first 5 days, and on the last day in the intensive care units. There was no statistical difference between two groups (p> 0.05), except for the second day. It was observed that there was a statistically significant difference between the pseudo-cholinesterase values in the second day comparison of both groups (p=0.028). Conclusion: In conclusion, plasmapheresis treatment may contribute positively to pseudo-cholinesterase level. This treatment may have provided additional time for the organophosphates to be eliminated from the body. Although acetyl cholinesterase reactivation is achieved with oxime treatment, the clinical effect of this treatment is not clear.

Anahtar Kelimeler

• Erythrocyte acetyl cholinesterase
• intensive care units
• Organophosphate poisoning
• plasmapheresis
• pseudo-cholinesterase.

Destekleyen Kurum

This study was supported by Erciyes University Scientific Research Committee.

Proje Numarası

Project no: TT-07-27, Gulten Can Sezgin

Organofosfat Zehirlenmesi Olan Kritik Hastalarda Plazmaferez ve Standart Tedavinin Serum Psödokolinesteraz ve Eritrosit Asetilkolinesteraz Düzeyleri Üzerindeki Etkisinin Standart Tedavi ile Karşılaştırılması: Randomize Kontrollü, Açık Etiketli, Klinik Çalışma

Öz

Amaç: Organofosfatlar dünya çapında yaygın olarak kullanılan insektisitlerdir. Organofosfat zehirlenmelerinde yetersiz tedavi morbidite ve mortaliteyi artırmaktadır. Çalışmanın amacı, organofosfat zehirlenmesi olan ciddi hastalarda serum psödo-kolinesteraz ve eritrosit asetil kolinesteraz düzeyleri üzerinde standart tedaviye karşı, standart tedavi artı plazmaferezin etkinliğini araştırmaktır. Materyal ve Method: Bu araştırma prospektif bir çalışmadır. Çalışmaya organofosfat zehirlenmesi tanısı alan hastalar dahil edildi. Hastalar müdahale grubu ve standart grup olarak iki gruba ayrıldı. Müdahale grubuna standart tedaviye ek olarak plazmaferez tedavisi uygulandı. Bulgular: Çalışmaya kırk hasta alınmıştır (müdahale grubu n:21, standart grup n:19). Başlangıçta serum psödo-kolinesteraz değerleri 482,5 u/L, plazmaferez sonrası 3723 u/L idi. Eritrosit asetil kolinesteraz değerleri başvuruda 1,91 u/mL, plazmaferez sonrası 2,53 u/mL idi. Eritrosit asetil kolinesteraz ve serum psödo-kolinesteraz değerleri hastaların yoğun bakıma kabulünden itibaren ilk 5 gün ve yoğun bakımdaki son gün değerleri iki grup arasında karşılaştırıldı. İki grup arasında 2. gün dışında istatistiksel fark yoktu (p> 0.05). Her iki grubun ikinci gün karşılaştırmasında psödo-kolinesteraz değerleri arasında istatistiksel olarak anlamlı fark olduğu görüldü (p=0,028). Sonuç: Sonuç olarak, plazmaferez tedavisi psödo-kolinesteraz düzeyine olumlu katkı sağlayabilir. Bu tedavi organofosfatların vücuttan atılması için ek süre sağlamış olabilir. Asetil kolinesteraz reaktivasyonu oksim tedavisi ile sağlansa da bu tedavinin klinik etkisi net değildir.

Anahtar Kelimeler

• Organophosphate poisoning
• erythrocyte acetyl cholinesterase
• pseudo-cholinesterase
• plasmapheresis
• ICU.

Proje Numarası

Project no: TT-07-27, Gulten Can Sezgin

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