Abstract：
OBJECTIVE: There is a lack of evidence on the effectiveness of antidotes in the management of organophosphate and carbamate (OPC) poisoning. We aimed to review the efficacy and safety of glycopyrrolate in the management of OPC poisoning.
METHODS: Databases such as PubMed, Scopus, Embase, and Cochrane Library were extensively searched from inception to November 2022 and updated till October 2023. Interventional, observational, and descriptive studies assessing the efficacy and safety of glycopyrrolate administered in any dose, route, and duration for the management of OPC poisoning published in the English language were considered for this review. The treatment with any other regimen that did not include glycopyrrolate was regarded as the comparator. The survival, intensive care unit (ICU) days and ventilatory outcomes were considered efficacy outcomes, and adverse effects were considered safety outcomes. Suitable quality assessment tools were used to assess the risk of bias in the included studies. Two independent reviewers were involved in the study selection, data extraction, and quality assessment and any discrepancies were resolved through mutual discussion or consultation with a third reviewer.
RESULTS: A total of 9 studies (2 RCTs, 4 cohorts, 1 case series, and 2 case reports) out of 591 nonduplicate records were considered for this review. Overall, the RCTs were observed to have a moderate quality, and observational studies and descriptive studies were found to have good quality. All the included studies used atropine administration as a standard treatment option along with glycopyrrolate. The OPC patients treated with glycopyrrolate had a fewer hospitalization days with comparable recovery and ventilatory outcomes than those that had not been treated with glycopyrrolate. The occurrence of adverse events and complications was lower in the glycopyrrolate group than in the control group.
CONCLUSIONS: Currently, there is a lack of comparative studies to recommend the use of glycopyrrolate in OPC poisoning, and further interventional studies are required to make an evidencebased recommendation on this topic.
METHODS: Databases such as PubMed, Scopus, Embase, and Cochrane Library were extensively searched from inception to November 2022 and updated till October 2023. Interventional, observational, and descriptive studies assessing the efficacy and safety of glycopyrrolate administered in any dose, route, and duration for the management of OPC poisoning published in the English language were considered for this review. The treatment with any other regimen that did not include glycopyrrolate was regarded as the comparator. The survival, intensive care unit (ICU) days and ventilatory outcomes were considered efficacy outcomes, and adverse effects were considered safety outcomes. Suitable quality assessment tools were used to assess the risk of bias in the included studies. Two independent reviewers were involved in the study selection, data extraction, and quality assessment and any discrepancies were resolved through mutual discussion or consultation with a third reviewer.
RESULTS: A total of 9 studies (2 RCTs, 4 cohorts, 1 case series, and 2 case reports) out of 591 nonduplicate records were considered for this review. Overall, the RCTs were observed to have a moderate quality, and observational studies and descriptive studies were found to have good quality. All the included studies used atropine administration as a standard treatment option along with glycopyrrolate. The OPC patients treated with glycopyrrolate had a fewer hospitalization days with comparable recovery and ventilatory outcomes than those that had not been treated with glycopyrrolate. The occurrence of adverse events and complications was lower in the glycopyrrolate group than in the control group.
CONCLUSIONS: Currently, there is a lack of comparative studies to recommend the use of glycopyrrolate in OPC poisoning, and further interventional studies are required to make an evidencebased recommendation on this topic.
摘要：
目的：关于解毒剂在有机磷和氨基甲酸酯（OPC）中毒治疗中的有效性缺乏证据。我们旨在回顾格隆溴铵在OPC中毒管理中的有效性和安全性。
方法：数据库，如PubMed、Scopus,Embase,和Cochrane图书馆从成立到2022年11月进行了广泛的搜索，并更新到2023年10月。介入性,观察,和描述性研究评估格隆溴铵以任何剂量给药的疗效和安全性，路线,本综述考虑了以英语发表的OPC中毒管理的持续时间。使用不包括格隆溴铵的任何其他方案的治疗被视为比较物。生存，重症监护病房（ICU）天数和通气结局被认为是疗效结局，不良反应被认为是安全性结局.使用合适的质量评估工具评估纳入研究的偏倚风险。两名独立审核员参与了研究选择，数据提取,和质量评估以及任何差异都是通过与第三名审查员相互讨论或协商解决的。
结果：共9项研究（2项RCT，4个队列，1个案例系列，和2例报告）本次审查考虑了591条非重复记录。总的来说,观察到RCT具有中等质量，观察性研究和描述性研究质量较好。所有纳入的研究都使用阿托品作为标准治疗选择以及格隆溴铵。与未使用格隆溴铵治疗的OPC患者相比，使用格隆溴铵治疗的OPC患者的住院天数较少，恢复和通气结局相似。格隆溴铵组的不良事件和并发症发生率低于对照组。
结论：目前，缺乏推荐在OPC中毒中使用格隆溴铵的比较研究，需要进一步的干预研究，以就该主题提出循证建议。
方法：数据库，如PubMed、Scopus,Embase,和Cochrane图书馆从成立到2022年11月进行了广泛的搜索，并更新到2023年10月。介入性,观察,和描述性研究评估格隆溴铵以任何剂量给药的疗效和安全性，路线,本综述考虑了以英语发表的OPC中毒管理的持续时间。使用不包括格隆溴铵的任何其他方案的治疗被视为比较物。生存，重症监护病房（ICU）天数和通气结局被认为是疗效结局，不良反应被认为是安全性结局.使用合适的质量评估工具评估纳入研究的偏倚风险。两名独立审核员参与了研究选择，数据提取,和质量评估以及任何差异都是通过与第三名审查员相互讨论或协商解决的。
结果：共9项研究（2项RCT，4个队列，1个案例系列，和2例报告）本次审查考虑了591条非重复记录。总的来说,观察到RCT具有中等质量，观察性研究和描述性研究质量较好。所有纳入的研究都使用阿托品作为标准治疗选择以及格隆溴铵。与未使用格隆溴铵治疗的OPC患者相比，使用格隆溴铵治疗的OPC患者的住院天数较少，恢复和通气结局相似。格隆溴铵组的不良事件和并发症发生率低于对照组。
结论：目前，缺乏推荐在OPC中毒中使用格隆溴铵的比较研究，需要进一步的干预研究，以就该主题提出循证建议。
