GBZ 8-2002Diagnostic Criteria of Occupational Acute Organophosphorus Insecticides Poisoning (English PDF)

Foreword

Article 6.1 of this standard is recommended and the remainder is mandatory.

According to the "People's Republic of China Occupational Disease Prevention Law" to develop this standard. Since the implementation of the standard date, the original standard GB 7794-1987 inconsistent with this standard, subject to this standard.

Acute poisoning can occur in occupational activities that are exposed to organophosphorus pesticides. To protect the health of the contact person, it is effective to control acute organophosphorus pesticide poisoning, has released GB 7794-1987.

The revised standard comprehensively summarizes the three clinical manifestations of the effects of organophosphorus pesticides on neurological toxicity, namely, inhibitors Acetylcholinesterase-induced acute cholinergic excitability or crisis, manifested as muscarinic, nicotine-like and central nervous system Symptoms; intermediate myasthenia gravis, manifested as the neck muscle and limb proximal muscles, the innervation of the muscles of the brain, and call Muscle strength weakened or paralysis; delayed multiple neuropathy, the performance of the distal limb for the heavy exercise and sensory disturbances.

Appendix A to this standard is an informative appendix.

This standard is proposed and centralized by the Ministry of Health of the People's Republic of China.

1 Scope

This standard specifies the principles of diagnosis and treatment of occupational acute organophosphorus pesticide poisoning.

This standard applies to the production and use of organic phosphorus insecticide and the occurrence of acute poisoning, life of organic phosphorus insecticide Toxic and organic phosphorus insecticide and other pesticide poisoning can also be used in this standard.

2 Normative reference documents

The terms of the following documents are hereby incorporated by reference into this standard. Any reference to the date of the document, all subsequent amendments (excluding corrigenda) or revisions do not apply to this standard, however, the parties to the standard agreement have studied whether the latest versions of these documents can be used. Whichever is not the date of the reference file, its the latest version applies to this standard.

GBZ 76 Occupational acute chemical poisoning Nervous system disease diagnostic criteria Standard Test Method for Occupational Acute Carbamate Insecticide Poisoning Identification of Occupational Injury and Occupational Disease Disability in Staff and Workers GB/T 16180

3 Diagnostic principles

According to a short period of exposure to a large number of organic phosphorus pesticide occupational history, to autonomic nerve, central nervous system and peripheral nervous system Symptoms of the main clinical manifestations, combined with the determination of blood cholinesterase activity, reference to the working environment of the labor hygiene survey Information, a comprehensive analysis, excluding other similar diseases, can be diagnosed.

4 Contact reaction

Has one of the following manifestations.

a) whole blood or erythrocyte cholinesterase activity below 70%, there is no obvious clinical manifestations of poisoning;

b) have mild muscarinic-like autonomic symptoms and/or central nervous system symptoms, whereas whole blood or erythrocyte choline Esterase activity is above 70%.

5 Diagnostic and grading standards

6 Principles of handling

7 Correctly use the instructions in this standard

See Appendix A (informative).

Appendix A

(Informative)

Correctly use the instructions in this standard A.1 acute organophosphorus pesticides and other pesticide poisoning, often with organic phosphorus pesticide poisoning clinical Performance-based, the diagnosis and diagnosis of grading can refer to this standard.

A.2 acute poisoning cholinergic canine-like muscarinic-like manifestations of loss of appetite, nausea, vomiting, abdominal pain, abdominal Diarrhea, salivation, sweating, blurred vision, miosis, increased respiratory secretions, bronchial spasm, dyspnea Difficult, pulmonary edema; nicotine-like performance for muscle bundle tremor, muscle spasms, muscle weakness, muscle paralysis; central nervous system System performance for headache, dizziness, insomnia or drowsiness, memory loss, fatigue, irritability, language barriers, mental Trance, convulsions, coma, brain edema.

A.3 intermediate myasthenia syndrome more common in acute moderate or severe poisoning after 1 to 4 days or so, occurred in acute Cholestatic crisis and delayed onset of multiple neuropathy, mainly due to neuromuscular junction postsynaptic resistance Stagnation, there may be some or all of the following three groups of muscle weakness or paralysis.

A.3.1 flexor muscle and limb proximal muscle symmetry muscle strength weakened. muscle strength is often 2 to 3, caused by supine Rise, upper limbs and lower limbs difficult to lift. Limb muscle tension is low or normal, tendon reflexes weakened or disappeared, not feeling Feel obstacle.

A.3.2 Nerve-dominated muscle weakness. can be involved in the first 3 to 7 and 9 to 12 on the innervation of the part of the brain Meat, eyes open difficulties, diplopia, chewing weakness, mouth difficulties, facial expression activities limited, swallowing difficulties, Hoarseness, tightening of the neck and shrug, or difficulties in stretching.

A.3.3 Respiratory muscle paralysis. chest tightness, shortness of breath, cyanosis, reduced respiratory tone, decreased muscle strength, Often developed rapidly for respiratory failure.

A.3.4 need to diagnose the disease with intermediate myasthenia gravis syndrome mainly acute organophosphate poisoning Jump ", Green - Bally syndrome and myasthenia gravis cholinergic crisis and so on.

A.4 Delayed multiple neuropathy is central - peripheral axonal disease, its occurrence and inhibition of cholinesterase Unrelated, more common in some organic phosphorus (such as methamidophos, trichlorfon, etc.) acute poisoning after 2 to 4 weeks, the performance of limbs Distal for heavy exercise and sensory disturbances. Should be associated with other causes of multiple neuropathy (see GBZ 76) and yes Identification of Phase I Myasthenia Gravis Syndrome in Phosphorus Insecticide.

A.5 The so-called "rebound" refers to a small number of acute poisoning patients after treatment improved, the cholinergic crisis to reproduce, and produce Heavier muscarinic, nicotinic and central nervous system clinical manifestations.

A.6 acute organophosphorus pesticide poisoning, especially in patients with severe poisoning, often can occur in varying degrees of cardiac damage harm. Mainly manifested as arrhythmia, ST-T changes and prolonged QT interval. Due to before the heart damage has been compared Typical cholinergic crisis of clinical manifestations, and abnormal cardiac performance is not as muscarinic, nicotine and Central nervous system symptoms specific, coupled with the difficulty of excluding severe poisoning hypoxia, electrolyte imbalance on the heart of the shadow Sound, so the heart damage is not included in the diagnosis and classification basis. In clinical practice, the introduction of organic phosphorus insecticide poisoning from the heart damage should be taken seriously.

A.7 acute poisoning diagnosis and classification of clinical manifestations as the main basis, reference to whole blood or erythrocyte cholinesterase activity the degree of decline. Blood cholinesterase activity test with thioacetyl-dithiobisobenzoic acid method (GBZ 52), portable cholinesterase assay and paper method, the standard of cholinesterase activity determination of the side Law is not unified.

A.8 The treatment of acute poisoning should take comprehensive measures, including the removal of pesticides and prevent the absorption of pesticides, early Rational use of special effects detoxification drugs and to give symptomatic and supportive care, three measures can not be neglected. Oral poisoning should be promptly and thoroughly with 2% sodium bicarbonate solution or water gastric lavage. For symptomatic contact reactors may be given appropriate treatment Treatment.

A.9 The principle of treatment of severe poisoning with atropine is "early, adequate, repeated administration" to reach Atto to prevent atropine poisoning. Atropine indications are pupil enlargement, facial redness, dry skin, mouth Dry, heart rate faster. When reaching atropine or muscarinic-like symptoms disappeared when appropriate, to extend the medication interval and maintain medication for several days.

A.10 cholinesterase complex agent on the phosphorus, parathion, phorate, ethionophos, borer, chlorpyrifos, Thiophosphate, phoxim, tep and other poisoning effect is better, against dichlorvos, trichlorfon, dimethoate, omethoate, horse Thiophosphate, diazepine and other poisoning efficacy is poor or ineffective. Toxicity of organic phosphorus insecticide effective for complexing agent, except to do Early application, should be based on the degree of poisoning, to give a reasonable dose and application time.

A.11 for organic phosphorus insecticide and pyrethroid mixed poisoning, should first be treated with organic phosphorus poisoning, and then Given symptomatic treatment. The organophosphorus pesticide and carbamate mixed poisoning, should be based on atropine treatment;

When the obvious nicotine-like symptoms, in close observation, the appropriate use of oxime complex agent.