The role of diazepam in the treatment of nerve agent poisoning in a civilian population.

Timothy C Marrs
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引用次数: 30

Abstract

The main site of action of diazepam, as with other benzodiazepines, is at the GABA(A) receptor, although it has been suggested that some of the potentially beneficial actions of diazepam in nerve agent poisoning are mediated through other means. It is likely that convulsions may have long-term sequelae in the central nervous system, because of damage by anoxia and/or excitotoxicity. Numerous pharmacodynamic studies of the action of diazepam in animals experimentally poisoned with nerve agents have been undertaken. In nearly all of these, diazepam has been studied in combination with other antidotes, such as atropine and/or pyridinium oximes, sometimes in combination with pyridostigmine pretreatment. These studies show that diazepam is an efficacious anticonvulsant in nerve agent poisoning. There is considerable experimental evidence to support the hypothesis that diazepam (and other anticonvulsants) may prevent structural damage to the central nervous system as evidenced by neuropathological changes such as neuronal necrosis at autopsy. In instances of nerve agent poisoning during terrorist use in Japan, diazepam seems to have been an effective anticonvulsant. Consequently, the use of diazepam is an important part of the treatment regimen of nerve agent poisoning, the aim being to prevent convulsions or reduce their duration. Diazepam should be given to patients poisoned with nerve agents whenever convulsions or muscle fasciculation are present. In severe poisoning, diazepam administration should be considered even before these complications occur. Diazepam is also useful as an anxiolytic in those exposed to nerve agents.

安定在治疗平民神经毒剂中毒中的作用。
与其他苯二氮卓类药物一样,地西泮的主要作用部位是GABA(A)受体,尽管有人认为,地西泮对神经毒剂中毒的一些潜在有益作用是通过其他途径介导的。由于缺氧和/或兴奋性毒性的损害,抽搐可能在中枢神经系统中有长期的后遗症。已经对地西泮在神经毒剂中毒动物体内的作用进行了大量的药效学研究。在几乎所有这些研究中,地西泮与其他解毒剂如阿托品和/或吡啶肟联合使用,有时与吡哆斯的明预处理联合使用。这些研究表明,地西泮是神经毒剂中毒的有效抗惊厥药。有相当多的实验证据支持地西泮(和其他抗惊厥药)可能防止中枢神经系统的结构性损伤的假设,如神经病理改变,如解剖时的神经元坏死。在日本恐怖分子使用神经毒剂中毒的例子中,地西泮似乎是一种有效的抗惊厥药。因此,使用地西泮是神经毒剂中毒治疗方案的重要组成部分,其目的是防止抽搐或缩短其持续时间。当神经毒剂中毒患者出现抽搐或肌肉抽搐时,应给予安定。严重中毒时,在这些并发症发生前就应考虑给予地西泮。地西泮对于神经毒剂中毒的患者也是一种有效的抗焦虑药。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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