Clinical analysis of penehyclidine hydrochloride combined with hemoperfusion in the treatment of acute severe organophosphorus pesticide poisoning

Abstract

ABSTRACT. This study aimed to observe the clinical curative effect of penehyclidine hydrochloride (PHC) combined with hemoperfusion in treating acute severe organophosphorus pesticide poisoning. We randomly divided 61 patients with severe organophosphorus pesticide poisoning into an experimental group (N = 31) and a control group (N = 30), and we compared the coma-recovery time, mechanical ventilation time, healing time, hospital expenses, and mortality between the two groups. The coma-recovery time, mechanical ventilation time, and healing time were lower in the experimental group than in the control group (P < 0.05), while the hospitalization expenses were higher in the experimental group than in the control group (P < 0.01); moreover, no significant difference was observed in the mortality rate between the two groups. Thus, PHC combined with hemoperfusion exerts a better therapeutic effect in acute severe organophosphorus pesticide poisoning than PHC alone.

Application of hemoperfusion in severe acute organophosphorus pesticide poisoning

“…Due to the short half-life, large dose, high risk of side effects, and tedious implementation, patients lack confidence in atropine therapy (7). Since the 1970s, hemoperfusion has been applied in the treatment of severe AOPP.…”

Role of penehyclidine in acute organophosphorus pesticide poisoning

“…Acute severe organophosphorus pesticide (OP) poisoning, which is defined as cholinesterase activity less than 30% in a patient presenting with an acute onset M-and N-cholinergic receptor activation syndrome, is a common type of accidental or suicidal pesticide poisoning in developing countries, [1] especially in rural China. [2,3] Although the mortality rate for OP poisonings World J Emerg Med, Vol 11, No 1, 2020 in China has dropped over the past several years, OP poisoning still accounts for more than half of all intoxication cases in emergency departments throughout China and leads to more than 80% of total poisoning deaths. [2,4,5] Anticholinergic agents are the cornerstone of therapy for relieving symptoms in OP patients, especially pulmonary edema.…”

“…[2,3] Although the mortality rate for OP poisonings World J Emerg Med, Vol 11, No 1, 2020 in China has dropped over the past several years, OP poisoning still accounts for more than half of all intoxication cases in emergency departments throughout China and leads to more than 80% of total poisoning deaths. [2,4,5] Anticholinergic agents are the cornerstone of therapy for relieving symptoms in OP patients, especially pulmonary edema. Atropine is the most commonly used anticholinergic antidote for treating cholinergic syndrome, especially in OP patients.…”

“…Atropine is the most commonly used anticholinergic antidote for treating cholinergic syndrome, especially in OP patients. [2,3,6] However, its M-receptor blockade ability sometimes leads to adverse effects on intoxicated patients, particularly concerning vital signs (e.g., elevated heart rate and blood pressure). In the initial phase of treating an OP poisoning patient in the emergency department, the proper initial dose of atropine is hard to judge and may lead to severe complications.…”

“…However, the time to atropinization is possibly prolonged due to the selectivity of penehyclidine as compared to the general cholinergic receptor-blocking ability of atropine, and penehyclidine needs longer period of time to reach functional volume in the blood as compared to atropine (almost 1 hour vs. 4-8 minutes). [13,14] Clinical observations showed that atropine combined with penehyclidine is a potentially effective therapy for OP poisoning patients, reducing the rate of adverse drug reactions (ADR) of atropine and improving overall prognosis. [3,10,15,16] Nevertheless, despite the affordable price for people in developing countries and wide usage of penehyclidine, it has not yet been clearly recommended in any guideline or consensus worldwide.…”