医院外突发急症现场自救互救知识讲座（十四）—急性中毒

毒物进入人体引起的疾病称为中毒。能进入人体内并对组织和器官造成物理和化学破坏的物质被称为毒物。世界上的毒物大约有 30 0 0 0种以上。毒物根据其毒性作用的大小可以分为剧毒和低毒 ,前者仅仅微量就能造成中毒 ,比如氰氢酸 ,口服 0 .0 6 g就可以置人死亡 ,后者只有达到一定的剂量才能造成中毒 ,比如酒精。1　毒物进入体内的途径1)经消化道吸收 :这是毒物进入体内最常见的形式 ,即饮用或食用了含有毒物的水、食物或有毒药物 ,然后毒物在胃肠道被吸收。2 )经皮肤和粘膜吸收 :一般情况下毒物是不容易经皮肤进入体内的 ,但皮肤及粘膜破损或…     

我国近五年急性中毒的文献分析

目的:通过对我国近五年来急性中毒的文献进行荟萃分析,了解我国急性中毒的临床特点.方法:查阅中国知网及万方数据库2006-2011年发表的急性中毒的相关文献,分析近五年急性中毒患者在性别、年龄、毒物类型、中毒途径、转归情况等方面的临床特点.结果:在查得的845篇文章中,有15篇文章符合要求,9篇文章统计了年龄段分布,10篇文章统计了中毒途径,10篇论文统计了转归情况,15篇文章均进行了性别和毒物类型的统计.结论:急性中毒在性别分布方面无明显差异;以20～39岁为高发年龄;中毒途径主要是经消化道;引起急性中毒的前五位的毒物分别是酒精、药物、农药、食物和CO;急性中毒的死亡率约为1.095％.     

洗胃术在抢救急性口服毒物中毒中的应用研究进展

洗胃在我国仍是抢救急性口服毒物中毒的重要措施,口服毒物中毒是生活中误服或有意自服而发生的中毒,是医院急诊科最常见的急症之一,它的发病时间与药物浸入的途经、毒性、剂量等有关。口服毒物中毒,情况紧急严重,若抢救不及时、治疗不当和观察护理不到位,可危及生命,而彻底清除胃肠毒物是抢救口服毒物中毒成功的关键。洗胃用物的合理选择,洗胃液的正确使用以及洗胃方法的不断改进是抢救成功的重要保证。     

洗胃术在抢救急性口服毒物中毒中的应用研究进展

洗胃在我国仍是抢救急性口服毒物中毒的重要措施,口服毒物中毒是生活中误服或有意自服而发生的中毒,是医院急诊科最常见的急症之一,它的发病时间与药物浸入的途经、毒性、剂量等有关。口服毒物中毒,情况紧急严重,若抢救不及时、治疗不当和观察护理不到位,可危及生命,而彻底清除胃肠毒物是抢救口服毒物中毒成功的关键。洗胃用物的合理选择,洗胃液的正确使用以及洗胃方法的不断改进是抢救成功的重要保证。     

急诊中毒洗胃抢救的护理配合

急诊中毒洗胃抢救的护理配合李小英广西合山市人民医院急诊科５４６５００洗胃是抢救各种经口中毒的常规措施之一,抢救服毒病人的首要问题是尽快彻底清除胃内毒物,减少毒物吸收。现结合本科多年来抢救中毒洗胃的工作经验,有如下几点体会。１洗胃所用器材如胃管、压舌板...     

基层医院急性中毒的特点与救治

目的探讨基层医院急性中毒患者的临床特征,为临床诊治提供较合理的依据。方法对我院2005年1月～2010年1月收治的86例急性中毒患者的临床资料进行回顾性分析。结果急性中毒患者占同期全部急诊病例的2.8%。男34例,女52例;年龄3～79岁,平均34岁,其中20～29岁23例,30～39岁20例。致病毒物主要有:酒精21例,动物毒素15例,植物毒素12例,化学药物类10例,农药9例,灭鼠药4例,食物7例,其他8例。中毒原因为有意接触毒物者51例,防护不周6例,意外事故29例。19例因病情严重转上级医院救治,其余病例在本院治愈。结论急性中毒在基层医院是比较常见的急诊急症,了解本地的中毒种类及临床特点,对提高防治能力,减少意外死亡是很有必要的。     

急性重度有机磷中毒合并呼吸衰竭急诊急救体会

目的研究急诊急救措施对急性重度有机磷中毒伴有呼吸衰竭患者的治疗效果影响。方法回顾性分析我院收治的42例急性重度有机磷中毒合并呼吸衰竭患者的临床治疗资料,所有患者均采用了清除呼吸道毒物、洗胃、基础药物治疗和机械通气辅助呼吸等治疗,总结有效急救措施和治疗经验。结果 42例患者,其中38例治愈,4例患者因心跳骤停或多器官功能衰竭而死亡。患者入院治疗7d后,胆碱酯酶和血氧饱和度均较入院治疗时有显著提高,差异显著。结论及时、彻底清除患者呼吸道和胃里的毒物,根据具体中毒症状给予足量解毒药物,采用机械通气辅助患者呼吸,维持水电解质的平衡和有效血氧饱和度,可显著提升患者的存活率和治愈率,减少后遗症的发生。     

急性有机磷农药中毒发病机制与治疗现状

AOPP是一种临床常见的中毒性疾病,具有发病急、发展快与死亡率高的特点。相关资料显示,该病在我国每年发生的中毒性病例中占20%～50%,病死率为3%～40%。本文就AOPP的发病机制、诊断标准及中毒分级、治疗措施等进行综述,旨在为临床研究与诊疗提供参考。     

床边血液灌流抢救重症药物或毒物中毒的体会

随着血液净化的发展，血液灌流已广泛用于重症药物、毒物中毒的抢救，床边血液灌流不受场地限制，使不宜搬动的重症患者得到及时的治疗。近两年来，我院应用床边血液灌流技术对45例重症药物或毒物中毒的患者进行治疗，取得良好的效果。     

国内简讯

功能性红曲的新型固态发酵技术；生物酶法促进生物柴油工业化；“生物毒素和中毒控制中常见毒物快速测定技术的研究”顺利通过验收；东阿阿胶集团推出指纹图谱蛋白测序对照检测方法；我国首次人工合成高纯度葡聚糖；利用基因技术促使老年骨缺损再生……     

Erythrogenic toxins A, B and C: Occurrence of the genes and exotoxin formation from clinical Streptococcus pyogenes strains associated with streptococcal toxic shock-like syndrome

We report the study of 53 clinical isolates of group A streptococci, all from patients with streptococcal toxic shock-like syndrome. The strains were analysed for the occurrence of the genes of erythrogenic toxins (pyrogenic exotoxins) types A, B and C and in vitro production of these toxins. In contrast to reports indicating that 85% of the toxic shock-like syndrome-associated isolates contained the erythrogenic toxin A gene, only 58.5% of our strains harboured this gene. The erythrogenic toxin C gene was detected in 22.6% of the isolates. Erythrogenic toxin A and erythrogenic toxin B were produced by 68.7% and 58.3% of the strains containing either gene. For all group A streptococci, irrespective of clinical association, the erythrogenic toxin B gene was detected in all the isolates tested. Thus, it is difficult to define a specific role for erythrogenic toxin B in toxic shock-like syndrome as there was no clear correlation between this disease and the presence of toxin genes. Our results suggest the existence of other pathogenic factor(s) produced by group A streptococci which may stimulate human peripheral T lymphocytes in a manner similar to that of erythrogenic toxins, thus explaining different observations in previous epidemiological genetic studies.     

Invasive infection caused Streptococcus group A and streptococcal toxic shock syndrome

Modern data on the etiology and pathogenesis of invasive streptococcal infection and the syndrome of streptococcal toxic shock are presented. In the course of the last 10-15 years essential changes in the system of interaction of group A streptococci and the macroorganism have been noted. The growth of morbidity in severe invasive forms of streptococcal infection with different clinical manifestations, including the syndrome of toxic shock, is observed. Most often this disease develops in elderly people, making up a group of risk, but sometimes affects healthy young people. Different pathogenicity factors of streptococci, capable of inducing the development of infection, are analyzed. Special attention is given to superantigens: pyrogenic toxins and M-protein. The suggestion that the development of the disease is seemingly linked with the state of specific protective immunity is substantiated. In spite of achievements in the field of the microbiology and immunology of group A streptococci, the causes of the appearance and development of invasive streptococcal infection have not yet been determined.     

Retrospective study of morbidity and mortality of captive jaguars (Panthera onca) in North America: 1982–2002

One hundred seventy‐two medical records of captive jaguars (Panthera onca) were examined from 30 American Zoo and Aquarium Association (AZA) institutions housing jaguars between 1982–2002. The study determined common causes of morbidity and mortality, and the influence of age, gender, and melengestrol‐acetate (MGA) exposure on these rates. The most common causes of morbidity in captive jaguars were found to be dental, gastrointestinal, integumentary, and musculoskeletal diseases. Prevalence of types of disease varied with age, with older animals experiencing a higher prevalence of multiple types of disease. Females developed reproductive disease more frequently than males, and the data suggest that MGA exposure increased the risk of developing female reproductive disease. The most common causes of mortality were reproductive diseases in females and musculoskeletal diseases in males. There was a high rate of neonate and pediatric mortality, primarily due to stillbirths or unexplained neonatal death, trauma, and pneumonia. Other diseases or clinical signs that seemed remarkable were a high prevalence of episodes of epistaxis among young, as well as old, jaguars. Based on these findings, management suggestions for the captive jaguar population are presented. Zoo Biol 0:1–12, 2006. © 2006 Wiley‐Liss, Inc.     

Analysis of the seasonality of acute intestinal diseases with regard to the detection of dysentery by antigen indication

Coincidence in the seasonal changes of the registered morbidity in dysentery and in other acute intestinal diseases is observed. The occurrence of Shigella antigens, detected with the use of erythrocyte diagnostic reagents, in the excreta of patients with the clinical diagnosis of dysentery and patients with other acute intestinal disease has a seasonal character, its peak coinciding with the period of increased morbidity in bacteriologically confirmed dysentery. The correction of monthly morbidity levels in dysentery and in other acute intestinal diseases with due regard for the proportion of Shigella antigens in the findings, made in the groups of patients with the clinical diagnosis of dysentery and with the diagnosis of other acute intestinal diseases for the corresponding month, has revealed that the actual morbidity in other acute intestinal diseases has a less pronounced seasonal character in comparison with the registered morbidity. This fact substantiates the statement that in the group of patients with other acute intestinal diseases a large proportion of such diseases is, actually, of a noninfectious nature.     

Modulation of tumour-induced bone resorption by bisphosphonates.

Tumour cells produce systemic or local factors which can stimulate osteoclast development and activity leading to increased bone resorption. The clinical consequences are bone pain, fractures and hypercalcaemia. Inhibitors of osteoclast-mediated bone resorption, such as the bisphosphonates, are now the treatment of choice for tumour-induced hypercalcaemia. Recent evidence indicates that these compounds, especially the newer ones, reduce skeletal morbidity in patients with metastatic bone disease and improve their quality of life. Better understanding of the mechanisms underlying tumour-induced bone resorption and development of more potent and less toxic bisphosphonates will lead to improved management of patients with malignant diseases involving the skeleton.     

海洋微藻溶血毒素研究进展

对海洋微藻溶血毒素的类型、理化性质、生物合成和毒性作用进行了综述,分析了存在的问题和应用前景的展望。     

Different response of the knockout mice lacking b-series gangliosides against botulinum and tetanus toxins

We assessed the response in knockout mice lacking the b-series (G(D2), G(D1b), G(T1b) and G(Q1b)) gangliosides against Clostridium botulinum (types A, B and E) and tetani toxins. We found that botulinum toxins were fully toxic, while tetanus toxin was much less toxic in the knockout mice. Combining the present results with our previous finding that tetanus toxin and botulinum types A and B toxins showed essentially no toxic activity in the knockout mice lacking both the a-series and b-series gangliosides (complex gangliosides), we concluded that the b-series gangliosides is the major essential substance for tetanus toxin, while b-series gangliosides may be not the essential substance for botulinum toxins, at the initial step during the intoxication process in mouse.     

Proteomic approaches for studying human parenchymal lung diseases

Parenchymal lung diseases comprise a wide variety of diseases, with different etiologies, pathogeneses and prognoses. This perspective provides an overview of two different disease types: chronic obstructive pulmonary disease and idiopathic pulmonary fibrosis. Chronic obstructive pulmonary disease, which is related to smoking, is one of the leading causes of chronic morbidity and mortality around the world, being characterized by airway obstruction and parenchymal lung damage (emphysema). Idiopathic pulmonary fibrosis of unknown etiology is classified as one of the most important idiopathic interstitial pneumonias and is connected to patchy but progressive lung fibrosis. Both diseases are generally diagnosed late and respond poorly to medical therapies. Although numerous biomarkers have been proposed for these diseases, they have not been validated or implemented into clinical practice. This perspective emphasizes some typical features of these diseases with different types of lung damage, how they are reflected in different samples, as well as potential advances and problems of current and future nonbiased proteomic approaches.     

Modulation of gut physiology through enteric toxins

Diarrheal diseases caused by microorganisms and their toxins are a major cause of mortality and morbidity throughout the world. Acute diarrhea is mainly caused due to increased intestinal secretion, commonly as a result of infection with enterotoxin producing organisms (enterotoxigenic Escherichia coli, Vibrio cholera) or due to decreased intestinal absorption from infection with organisms that damage the intestinal epithelium (enteropathogenic E. coli sp., Shigella sp., Salmonella sp.) The studies of the impact of enteric pathogens and their virulence factors exert their effect by producing toxins, called bacterial toxins. The protein toxins are produced by diverse group of bacteria. Most of the bacterial toxins exert their effect through involvement of ADP-ribosylation proteins; otherwise essential for several cellular functions while other toxins involve guanylate cyclase systems or calcium and protein kinases for their ultimate action.     

血浆游离DNA检测在心血管系统疾病诊断中的应用

心血管疾病发病率和病死率居高不下,寻求敏感性高的生物学指标帮助早期诊断和改善预后意义重大.血浆游离DNA(cell-free DNA,cfDNA)是一类存在于血浆、尿液及其他体液中游离于细胞之外的双链DNA片段.血浆cfDNA水平在心血管疾病的早期明显升高,提示其可能是心血管疾病的潜在生物标志物.为了更深入理解cfDN...