[논문]아트로핀으로 치료하는 유기인계와 카바메이트 중독 환자의 영양지원 평가와 방법

박종욱; 민영기; 최상천; 고동완; 박은정

doi:10.22537/jksct.2020.18.2.123

[국내논문] 아트로핀으로 치료하는 유기인계와 카바메이트 중독 환자의 영양지원 평가와 방법
Assessment and Methods of Nutritional Support during Atropinization in Organophosphate and Carbamate Poisoning Cases 원문보기

대한임상독성학회지 = Journal of the Korean society of clinical toxicology, v.18 no.2, 2020년, pp.123 - 129

박종욱 (아주대학교 의과대학 응급의학교실) , 민영기 (아주대학교 의과대학 응급의학교실) , 최상천 (아주대학교 의과대학 응급의학교실) , 고동완 (아주대학교 의과대학 응급의학교실) , 박은정 (아주대학교 의과대학 응급의학교실)

Abstract ▼ AI-Helper

Purpose: Atropine is an antidote used to relieve muscarinic symptoms in patients with organophosphate and carbamate poisoning. Nutritional support via the enteral nutrition (EN) route might be associated with improved clinical outcomes in critically ill patients. This study examined the administration of nutritional support in patients undergoing atropinization, including methods of supply, outcomes, and complications. Methods: A retrospective observational study was conducted in a tertiary care teaching hospital from 2010 to 2018. Forty-five patients, who were administered with atropine and on mechanical ventilation (MV) due to organophosphate or carbamate poisoning, were enrolled. Results: Nutritional support was initiated on the third day of hospitalization. Thirty-three patients (73.3%) were initially supported using parenteral nutrition (PN). During atropinization, 32 patients (71.1%) received nutritional support via EN (9) or PN (23). There was no obvious reason for not starting EN during atropinization (61.1%). Pneumonia was observed in both patient groups on EN and PN (p=0.049). Patients without nutritional support had a shorter MV duration (p=0.034) than patients with nutritional support. The methods of nutritional support during atropinization did not show differences in the number of hospital days (p=0.711), MV duration (p=0.933), duration of ICU stay (p=0.850), or recovery at discharge (p=0.197). Conclusion: Most patients undergoing atropinization were administered PN without obvious reasons to preclude EN. Nutritional support was not correlated with the treatment outcomes or pneumonia. From these results, it might be possible to choose EN in patients undergoing atropinization, but further studies will be necessary.

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문제 정의

This study aimed to observe the administration of nutri- tional support in patients with organophosphate or carba- mate poisoning, including methods of nutritional support during atropinization. We also aimed to determine the rela- tionship between nutritional support and treatment out- comes and infectious complications.
This study characterized the administration of nutritional support in patients undergoing atropinization, especially according to methods of nutrition, related complications, and the effects of nutritional support. Thirty-three patients (73.

제안 방법

This study has several limitations. Firstly, this study was conducted retrospectively in a single center with a small sample size, and the results may lack the scientific validity required for generalization of research findings, and a small sample size in clinical trials may not yield a valid conclu- sion. Secondly, we cannot describe the reasons not starting nutritional support and the factors affecting the choice of nutritional support method.

대상 데이터

Five patients who died within 48 hours and three patients who were dis- charged within 48 hours were excluded. Finally, 45 patients were included in the study.

데이터처리

The Mann-Whitney test or Spearman’s correlation analysis was used to compare the continuous variables. Categorical variables were expressed as frequencies and percentages, and comparisons were performed using the Fisher’s exact test. Data were analyzed using SPSS ver.

이론/모형

The Mann-Whitney test or Spearman’s correlation analysis was used to compare the continuous variables. Categorical variables were expressed as frequencies and percentages, and comparisons were performed using the Fisher’s exact test.

성능/효과

To assess the severity in patients with acute symptoms of organophosphate or car- bamate poisoning, SOFA was collected16). Nutritional screening results, nutritional support methods, dates of ini- tiation of treatment, amount of support at day 3 after admis- sion, and complications related to nutritional support were reviewed. Outcomes including hospital day (HD), MV duration, and ICU stay duration were collected.
In conclusion, most patients undergoing atropinization owing to organophosphate or carbamate poisoning were nutritionally supported via PN. There was no obvious rea- son not to start EN during atropinization in most cases.

후속연구

Secondly, we cannot describe the reasons not starting nutritional support and the factors affecting the choice of nutritional support method. Further study would be helpful to identify factors related to choosing the methods of nutri- tional support. Thirdly, the nutritional risk was low in this study population.

참고문헌 (23)

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