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...     

重度有机磷农药中毒抢救的临床分析

目的总结有机磷农药中毒抢救的方法和经验。方法收集近年救治的重度有机磷中毒患者的临床资料,并进行回顾性分析。结果 13例重度有机磷中毒患者均抢救成功,无后遗症。结论口服有机磷农药中毒的病情凶险,发展迅速,其严重程度与中毒的途径、中毒时间,吸入剂量、农药的毒性,患者健康状况密切相关,抢救时机、药物的合理应用、抢救方法是否得当是成功的关键。     

有机磷农药中毒的护理

目的:本文通过对1例口服有机磷中毒患者的抢救护理,作出了护理总结。方法:洗胃,抢救,护理。同时要观察有无肺水肿,脑水肿,呼吸衰竭这三大并发症。结果:最终痊愈。结论:我们体会到抢救护理的速度和质量是决定患者生死的关键,预防和治疗并发症是护理的重点。     

122例重症有机磷农药中毒患者的救治体会

目的总结重症有机磷农药中毒的救治效果,以提高救治成功率。方法对2009年6月~2014年6月我院急诊救治重症有机磷农药中毒患者122例的临床资料进行总结。结果成功治愈120例,2例因多器官衰竭死亡。结论及时洗胃,机械通气呼吸支持,配合抗胆碱药及有机磷解毒剂治疗,是提高有机磷中毒致呼吸衰竭抢救成功的有效措施。     

有机磷农药中毒救治初探

目的 探讨有机磷农药中毒(AOPP)的抢救方法.方法 对大连市金州区第三人民医院1995年9月至2011年9月共收治20例有机磷农药中毒患者的病例进行回顾性分析.结果 18例治愈,2例转到上级医院治疗.平均住院8.5d.结论 抢救有机磷农药中毒,洗胃是关键措施之一.快速达到阿托品化是抢救有机磷农药中毒成功与否的另一关键性措施.     

急诊洗胃的护理体会

目的观察急诊洗胃对急性中毒的效果。方法对128例急性中毒患者利用胃管插入的方法进行洗胃治疗的资料进行分析。结果 128例患者均能顺利插入胃管,其中7例出现轻微的并发症,经过处理后均能治愈,其余无特殊不良反应,均达到了清除胃内毒物的目的。结论患者在服毒后及时、规范的洗胃治疗,可明显提高生存率;而娴熟的急救洗胃护理技术是成功的关键。     

急性利培酮中毒救治的临床分析

目的 探讨急性利培酮中毒的发病机制和治疗措施.方法 选择急性利培酮中毒患者18例,应用洗胃、补液、利尿及对症处理等综合治疗.结果 经综合措施治疗,18例患者均痊愈出院.结论 综合救治措施是抢救急性利培酮中毒的有效方法 .     

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…     

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。     

Comparative study of cases of poisoning by organophosphorous insecticides in various regions of Costa Rica

336 cases of organophosphorous poisoning from case records of hospitals in Costa Rica between 1972 and 1978 were classified in four categories according to signs and symptoms: 8% latent; 25.9% mild; 43.8% moderate and 22.3% severe. Eighteen of the total patients died during hospitalization. Suicidal ingestion was the principal cause of severe and latent poisoning, especially in urban areas, followed by occupational poisoning in agricultural workers in mild and moderate cases. Occupational poisoning was common in men; in women it was attempted suicide and in children accidental poisoning. Under 40 years of age, the main cause was suicidal ingestion among both men and women, and occupational poisoning after 40 years of age. After discharge from the hospital, 19.6% of the total poisoned patients were referred to psychiatric treatment; 22.7% and 18.2% had had mental and alcoholic problems, respectively, prior to poisoning. Attempted suicide was the principal cause of poisoning in 86.4% of these patients, indicating emotional instability. In this study, the incidence in psychiatric consultation after discharge from the hospital is not indicative of a relationship between mental disorders and acute insecticide poisoning. In 42.6% and in 22% of the deceased patients pralidoxime (PAM) and atropine respectively, were not administered as antidotes in the emergency room. Aminophylline and skeletal muscle relaxants among other contraindicated drugs were administered as part of the treatment in these deceased patients. The consequences of this misguided treatment are questioned.     

Mushroom Poisoning in Canada: Report of a Fatal Case

At least 150 cases of mushroom poisoning occur in Canada each year, 75% in the Province of Ontario. Eighty per cent of the total are in children under the age of 9, and most do not require hospitalization. Amanita virosa poisoning is a potentially fatal medical emergency which presents as an acute gastroenteritis, progressing to hepatorenal failure. Treatment consists of elimination of undigested mushrooms, rapid rehydration, management of acute liver and renal failure, and prevention of infection during the recovery phase.     

急性一氧化碳中毒致心肌损害临床研究

目的研究急性一氧化碳（CO）中毒对心脏的损害。方法选择急诊入院的急性CO中毒患者102例,分为轻度、中度和重度中毒组,同时在健康体检人群中随机选择100例健康人为对照组。中毒组的病例入院24h采静脉血测定心肌酶及行心电图检查;对照组清晨抽空腹静脉血．测定心肌酶并完成12导联心电图描记。结果急性CO中毒患者中有63例血清心肌酶谱改变,占61.77％。中、重度中毒者多有不同程度的心肌酶升高,与健康对照组相比,差异有统计学意义（P〈0．01）;重、中度中毒组相比。差异亦有统计学意义（P〈0．01）。心电图异常改变有70例．占68．63％。经治疗,除2例病重无康复外．其余100例均康复出院．在CO中毒纠正后心肌酶和心电图均恢复正常。蛄论急性CO中毒不仅对神经系统造成损害．对心脏的损害也较严重,需要给予相应的治疗.     

Simultaneous quantification of VX and its toxic metabolite in blood and plasma samples and its application for in vivo and in vitro toxicological studies

The present study was initiated to develop a sensitive and highly selective method for the simultaneous quantification of the nerve agent VX (O-ethyl S-[2(diisopropylamino)ethyl] methylphosphonothioate) and its toxic metabolite (EA-2192) in blood and plasma samples in vivo and in vitro. For the quantitative detection of VX and EA-2192 the resolution was realized on a HYPERCARB HPLC phase. A specific procedure was developed to isolate both toxic analytes from blood and plasma samples. The limit of detection was 0.1 pg/ml and the absolute recovery of the overall sample preparation procedure was 74% for VX and 69% for EA-2192. After intravenous and percutaneous administration of a supralethal doses of VX in anaesthetised swine both VX and EA-2192 could be quantified over 540 min following exposure. This study is the first to verify the in vivo formation of the toxic metabolite EA-2192 after poisoning with the nerve agent VX. Further toxicokinetic and therapeutic studies are required in order to determine the impact of EA-2192 on the treatment of acute VX poisoning.     

Risk and Prognostic Factors of Inpatient Mortality Associated with Unintentional Insecticide and Herbicide Poisonings: A Retrospective Cohort Study

Introduction

Pesticide poisoning is an important public health problem worldwide. The study aimed to determine the risk of all-cause and cause-specific inpatient mortality and to identify prognostic factors for inpatient mortality associated with unintentional insecticide and herbicide pesticide poisonings.

Methods

We performed a retrospective cohort study of 3,986 inpatients recruited at hospitalization between 1999 and 2008 in Taiwan. We used the International Classification of Disease, 9th ed., Clinical Modification external causes of injury codes to classify poisoning agents into accidental poisoning by insecticides and herbicides. Comparisons in mortality rates were made between insecticide poisoning patients and herbicide poisoning patients by using the Cox proportional hazards models to estimate multivariable-adjusted hazard ratios (HRs) and their 95% confidence intervals (CIs).

Results

There were 168 deaths during 21,583 person-days of follow-up evaluation (7.8 per 1,000 person-days). The major causes of mortality for insecticide poisonings were the toxic effect of organophosphate and coma, and the major causes of mortality for herbicide poisonings were the toxic effect of other pesticides and the toxic effect of organophosphate. The mortality for herbicide exposure was fourfold higher than that for insecticide exposure. The factors associated with inpatient mortality were herbicide poisonings (HR = 4.58, 95% CI 3.29 to 6.37) and receiving mechanical ventilation treatment (HR = 3.85, 95% CI 2.73 to 5.42).

Conclusions

We demonstrated that herbicides stand out as the dominant agent for poisoning-related fatalities. The control of and limiting access to herbicide agents and developing appropriate therapeutic regimens, including emergency care, should be priorities.     

Evolution of emergency cardiac care in Canada.

Acute myocardial infarction is the most common cause of death in Canada. Most deaths occur within the first 2 hours of the onset of symptoms, before the person seeks or is able to obtain medical aid, and are due to arrhythmias rather than massive myocardial damage. Effective electrical and drug treatment of arrhythmias has reduced the hospital mortality but not the community mortality. If mortality from acute myocardial infarction and other causes of sudden unexpected death is to be reduced substantially a major reorganization of emergency medical services is needed so that the benefits of the modern coronary care unit can be provided to the patient as rapidly as possible. Public education in basic life support procedures to sustain life until advanced life support aid arrives is the first step towards the development of a more effective system of emergency cardiac care.     

解磷注射液急诊治疗有机磷农药中毒的临床分析

目的：探讨解磷注射液急诊治疗有机磷农药中毒的临床疗效。方法：选取2009年10月-2011年8月于我院进行治疗的216例有机磷农药中毒的患者为研究对象,将所有患者随机分为观察组（解磷注射液组）108例和对照组（阿托品组）108例,后将两组患者治愈率、治愈时间、死亡率和住院天数情况进行统计及比较。结果：观察组患者治愈率和治愈时间显优于对照组,且死亡率和住院天数也明显低于对照组,均P〈0．05,有显著性差异。结论：解磷注射液急诊治疗有机磷农药中毒患者的效果显著,应在有机磷农药中毒的患者中广泛使用。     

Acute Paracetamol Poisoning

Of 41 cases of acute paracetamol poisoning one died of gastrointestinal haemorrhage and acute massive necrosis of the liver, three became jaundiced, and 13 others had biochemical evidence of hepatocellular damage. Liver damage is a toxic effect which is present in most patients who ingest more than 15 g. of paracetamol. One patient with liver damage survived renal failure due to acute tubular necrosis. It is suggested that the renal lesion was also the result of paracetamol overdosage.Profound hypoglycaemia and metabolic acidosis may also complicate severe poisoning. Plasma levels of para-aminophenol fall rapidly, and procedures currently used to enhance the elimination of the drug cannot be expected to prevent development of hepatic damage.     

Effects of a Combination of Atropine,Metaraminol and Pyridine Aldoxime Methanesulfonate (AMP Therapy) on Normal Human Subjects

Four hundred and seventeen medical students at the University of Toronto were used as both subjects and observers in a series of double-blind experiments to determine possible toxic effects following oral ingestion of various combinations of 2 mg. atropine, 10 mg. metaraminol and 1 g. pyridine aldoxime methanesulfonate (P₂S). Heart rate, blood pressure, pupil diameter, and visual accommodation were measured before and at 20-minute intervals after drug administration for 100 minutes. A visual and memory perceptual test (Mackworth) was performed before and 100 minutes after drug ingestion.No toxic effects were observed following administration of the triple combination of atropine, metaraminol and P₂S (AMP therapy). The AMP combination might be useful prophylactically for persons facing exposure to organophosphorus anticholinesterase compounds. It must not be considered an adequate substitute for treatment should poisoning occur.