Organophosphates: chikumbiro, matanho uye ine nheyo. Organophosphate chepfu, rwekutanga

Organophosphates makemikari Mapato, yakaitirwa kuuraya sora, zvipembenene nemakonzo.

zvipembenene izvi zvinonzi nevakawanda kushandiswa kwete chete mune zvokurima asiwo muupenyu hwezuva nezuva. mhando dzakawanda vesiputous dzine chepfu uye zvinogona kukonzera zvakakomba chepfu kubudikidza ingestion zvose mukati mumuviri uye neVadzidzi nasal mucosa uye ziso, uye kunyange vane yakasimba ganda.

Statistics vesiputous chepfu

Chenjera kudhaka kubudikidza organophosphorus yeimwe chaizvoizvo kunoitika pakutanga pakati mamwe exogenous chepfu kwete chete giravhiti asiwo maitikiro. Lethality chepfu kwakadaro anenge 20%, asi kakawanda - vanenge 15% vose nyaya kudhaka. Kufarira ndechokuti emandiriri mushonga organophosphate nomuchetura ndiro doro. In varwere vaiva ezvinhu yokunyanyisa kudhaka panguva nomuchetura zvipembenene, chirwere nyore zvikuru (nokugwinha uye paresis ari kufema tsandanyama havasi kuwanikwa). Zvisinei, hemodynamic zvirwere zvingava zvikuru raidudzwa.

Possible zvinokonzera nomuchetura zvipembenene

Organophosphate chepfu kungava nokuda Occupational uye kuitika nokuda pakugadzirisa zvisina kufanira zvine chepfu. Kuregeredza mumwe kana kupfuura vanhu vanogona kuguma kwete chete chakakomba chepfu pachavo asi kutungamirira vakawanda kudhaka.

Kuwedzera iyi chepfu kubudikidza organophosphorus yeimwe zvinogona aipfeka nezuva hunhu. The zvinokonzera tsaona dzinogona kuva zvakasiyana, somuenzaniso:

• hapana zviratidzo midziyo Nokuparadzwa mvura, akachengetwa kumba (munhu anogona kutora chepfu mukati chikanganiso kana ndeimwewo nechinangwa kudhaka);
• kuchengetera zvipembenene vari kuwana vana (vana pachisikirwo kuziva chaizvo, uye kunyange kana munhu mudziyo kuti chepfu achaiswa akasaina, mwana muduku anogona achiri kunwa mvura ngozi uye vawane rikwanise chepfu);
• kukundikana kutevedza nekuchengetedzwa mitemo (kuregeredza zvinoreva kudzivirira kana anoshandiswa mhuri zvine chepfu, zvakadai seguruva chifukidzo, magiravhusi, magogorosi, rokudzivirira zvipfeko).

Kana organophosphorus mukomboni huru mishonga kuwira mukati muviri, vanogona kukonzera maronda-siyana dzenyika nechepakati tsinga inoenda neuritis, rutivi rwomuviri uye zvimwe migumisiro, kusanganisira rufu.

Kupatsanura pakati organophosphorus yeimwe pamusoro toxicity

• kuti chepfu kupfuura - yakavakirwa zvipembenene thiophos, Metaphos, merkaptofosa, octamethyl;
• chepfu - zvinodhaka kwakavakirwa demeton-s-methyl, phosphamide, dichlorophosphate;
• srednetoksichnye - trichlorfon, malathion, metilnitrofos uye zvipembenene kunobva kwavari, uyewo sayfos, cyanophos, tribufos;
• yakaderera-toxicity - demufos, bromophos, temephos.

Zviratidzo nomuchetura vesiputous

Maererano dhigirii nomuchetura regiravhiti vari muzvikamu 3 nzendo. Clinic organophosphate chepfu ari sezvinotevera:

Munyoro kudhaka (I Stage):

• psychomotor kugadzikana uye kunzwa kutya;
• kupfupika mweya;
• dilated vadzidzi (miosis);
• spastic kurwadziwa mudumbu;
• wakawedzera salivation uye kurutsa;
• kwazvo nomusoro;
• cheBP;
• kunonyengedza vangadikitira;
• wheezing.

At mwero chimiro (II Danho):

• kugadzikana inogona kuchengetedzwa kana zvishoma yakatsiva chinovhiringidza, uye dzimwe nguva - uye chaanoziva;
• nemuumbi miosis, mboni kuti chiedza vanokundikana kupindura;
• maximally kuratidza zviratidzo hyperhidrosis (maximized salivation (mate), vangadikitira, bronhoreya (phlegm kubva principales));
• fibrillar twitching anopenya, tsandanyama pechipfuva, makumbo, uye dzimwe nguva dzose dzemuviri;
• nenguva dzirikure pakuonekwa hyper zvachose tsandanyama muviri, tonic nokugwinha;
• zvinoshamisa anowedzera mataurire pechipfuva;
• BP rinosvika vaifanira unongotaura (250/160);
• involuntary defecation uye weti, achiperekedzwa kunorwadza tenesmus (zvido venhema).

Zvakakomba chepfu (III Danho):

• murwere rikawira mugomba rakadzika chaanoziva;
• hunenge All vari simba kana zvachose ndisipo;
• zvakakomba hypoxia;
• iziviswe miosis;
• ndichengetedze hyperhidrosis zviratidzo;
• kuchinja tsandanyama hypertonus, miofibrillyatsii uye tonic nokugwinha mutezo tsandanyama rudekaro;
• mwoyo zvakasimba afemeruke kudzika uye kakawanda kundosvikira vari kutadza, zvinokwanisika kufema kuremara;
• kwemwoyo iri akatura kuna dzinonetsa zviratidzo (40-20 min.);
• tachycardia kunowedzera (anorova anopfuura 120 paminiti min.);
• BP anoramba kuwira;
• kuva chepfu encephalopathy pamwe edema uye hemorrhages dzakawanda diapedetic zvinganaka yakavhenganiswa mhando, nokuda kuoma kufema tsandanyama uye chinovhiringidza ari kufema centre;
• ganda payakakurudzirwa anowa rinowanika cyanosis (ganda uye mucous membranes kuva rinokwanisa kucheneruka ruvara).

Migumisiro nomuchetura phosphorus zvipembenene

Kana muviri kuwira organophosphorus yeimwe, rubatsiro rwekutanga rakashandurwa nokukurumidza uye zvakanaka, mumwe chinokosha zvinoita kuti kuona mberi weboka chirwere. Vesiputous kudhaka chirwere zviri nyore kuisa maitiro kunotoda mufananidzo Zvisinei, ndewekuti Zvaizobuda zvakanaka kana munhu afa, zvinoenderana arambe zvokurapa.

Nokuda mukuru toxicity kuti organophosphorus yeimwe kana anwa kuita irreparable zvinokuvadza zvinenge zvose zvinokosha nhengo uye hurongwa. Nezvenyaya iyi, kunyange yakanaka mugumisiro kudzorera zvakazara mashandiro vamwe nhengo dziri kutadza.

Pakati matambudziko, izvo kazhinji pamwe zvikuru kudhaka kubudikidza organophosphorus yeimwe zvinosanganisira nemabayo, cardiac arrhythmias uye cardiac conduction, fuma Kutemeswa psychosis ari rikwanise chimiro, etc.

chirwere

Mumazuva mashoma okutanga mushure chepfu, murwere ari mamiriro ezvinhu akaoma kunokonzerwa zvemwoyo akawisa. Kwozouya zvishoma nezvishoma muripo uye kunonatsiridza utano. Zvisinei, pashure pevhiki 2-3, zvinokwanisika kukura zvikuru chepfu polyneuropathy. Mune zvimwe zviitiko, izvi zvingaita kuti wandei cranial tsinga.

Munguva polyneuropathy izvi pashure zvakakwana refu, dzimwe nguva achiperekedzwa kuramba kufamba zvirwere. Dzoserai mabasa ose peripheral tsinga kwakaipa. Zvinogona kuitika kudzoka chakasimba zvirwere, zvakadai cholinergic dambudziko. Chikonzero ndechokuti rakachengetedzwa organophosphorus remubatanidzwa "vabudiswa" kubva munyama siyana munzvimbo kweropa hurongwa.

mabatiro

Kana nyaya dzakakomba chepfu nokuda organophosphorus yeimwe, rubatsiro rwekutanga anofanira kusanganisira hasha kuchenesa pamusoro zvomudumbu turakiti kubudikidza gastric lavage uchishandisa vachiongorora kumanikidzwa diuresis, nezvimwewo, kwerunyararo afemeruke uye kushandisa dzakananga mushonga. Uyezve, kunzwisisa kuti nokumutswa, kusanganisira pharmacotherapy, zvainanga kuramba uye kudzorera ukama muviri mashandiro, kusanganisira matanho kudzorera cardiac basa, mabatiro kusagadzikana homeostasis uye exotoxic kuvhunduka.

Kudzorerwa kufema shanda

Organophosphorus yeimwe inobatwa mumuviri akawanda, kazhinji kukonzera kufema rokutambudzika, kunokonzerwa nokutaurisa oropharyngeal secretion, uye bronchoconstriction kuoma kufema tsandanyama. Maererano neizvi, chinhu chokutanga kuti vanachiremba vari kuedza kuita - ndiko kuti adzorere yemweya uye nechokwadi yakakwana kufefetedza. In pamberi vomitus zhinji uye oropharyngeal zvinoerera, rinoshanda chido (yaunodya kuti mvura nokuda Vacuum). In chenjera chepfu vesiputous nokumutswa zvinosanganisira endotracheal intubation, zvokuimba kufefetedza.

mushonga kurapa

Application safeners (mushonga) iri chinhu chinokosha zvashata pharmacotherapy iri rikwanise chepfu. Zvinodhaka muboka iri sei kinetics iri muviri zvine chepfu, zvinopa Absorção de Água kwayo kana kubviswa, nechepazasi zvazvinoita toxin receptors kudzivirira metabolize ngozi uye achabvisa ngozi nepfungwa dzinokosha muviri mashandiro, kunokonzerwa kudhaka.

Mushonga muchetura kubudikidza organophosphorus yeimwe akatorwa pamwe nemamwe zvinodhaka kushandiswa. Pharmacotherapy inoitwa kufanana mukuru nokumutswa uye detoxifying kuchirapa matanho.

Zvinofanira kurangarirwa kuti hapana mukana pakarepo nokumutswa, upenyu akuvara angaponeswa chete mushonga organophosphorus yeimwe, uye nokukurumidza riri vakasuma, nani mukana akuvara achava yakanaka Zvaizobuda chirwere.

kupatsanura pakati mushonga

Mushonga dzinoiswa muzvikwata zvina:

• symptomatic (pharmacological);
• nemakemikari (toxicokinetic);
• mushonga (toksikotropnye);
• antitoxic Immunopreparat.

Kana zviratidzo zvokutanga organophosphate chepfu, asi danho dogospitalizatsii akuvara, uye kushandisa mushonga mapoka toksikotropnoy symptomatic, sezvo vane ainyatsoratidza kuti kushandiswa. Kugadzirira toxicokinetic chiito zvinoda kunyatsotevedza mirayiridzo, nokuti amburenzi vanachiremba havagoni zvakarurama nguva dzose kuona zvairatidza kuti vashandise. Antitoxic Immunopreparat anoshandiswa sangano kuchipatara.

Dzakananga kurapa iri rikwanise chepfu kubudikidza organophosphorus yeimwe

Complex zviitiko unotora kushandisa anticholinergics (atropine mhando mishonga) Rakabatanidzwa pamwe cholinesterase reactivator. In awa rokutanga pashure muchipatara inoitwa ndichibvunza atropine. Atropine huru mishonga chinotarisirwa nomutsinga zvakazorodza zvezvinoratidza hyperhidrosis iripo. Ko kuva zviratidzo simba zvinodhaka ovhadhozi, akaratidza ganda yakaoma uye zvine mwero tachycardia.

Kuti tirambe mamiriro iyi atropine chinotarisirwa kakawanda, asi mishonga zviduku. Kutsigira atropinization pave anosimbirira blockade kuti M-cholinoreactive gadziriro dzaparadzwa muviri Anti-zvinodhaka chiitiko acetylcholine pamusoro nguva inodiwa kuti kuparadzwa uye kubviswa tsvina.

Modern Reaktivatory cholinesterase kukwanisa zvinobudirira kuwedzera akamanikidzwa cholinesterase uye neutralize siyana phosphorus yeimwe. Paaiita dzakananga kurapa ari kuongororwa nguva dzose cholinesterase basa.