毒蛇咬伤致急性呼吸衰竭的机械通气救治6例

目的 探讨机械通气救治毒蛇咬伤致急性呼吸衰竭的治疗效果。方法 用机械通气救治6例毒蛇咬伤致急性呼吸衰竭患者。结果 气管内插管是最佳的气道开放方法;控制通气时,理想的参数为潮气量12ml/kg,通气频率20次／分,呼吸比1：2,吸氧浓度0. 4;辅助通气是,压力支持通气为0.3-1.5kPa,触发敏感度为－3mmH2D。气管插管者辅助通气4－6h后撤机及拔管可获得成功。结论 气管内插管及机械通气是救治毒蛇咬伤致急性呼吸衰竭的最有效的方法。     

80例神经毒类毒蛇咬伤的流行病学特点及急诊救治

目的总结分析80例神经毒类毒蛇咬伤的流行病学特点及急诊救治经验。方法收集80例神经毒类毒蛇咬伤的临床资料,分析其临床特点并总结救治经验和体会。结果 80例神经毒类毒蛇咬伤抢救成功率100%,痊愈率100%,总有效率100%。结论综合治疗神经毒类毒蛇咬伤的疗效显著。早期使用氧疗和机械辅助呼吸以及抗蛇毒血清等治疗方法是神经毒类毒蛇咬伤呼吸衰竭抢救成功的关键。     

重危型蝮蛇咬伤血清钾和心电图改变的临床分析

目的 探讨重危型蝮蛇咬伤患者血清钾和心电图改变的临床意义.方法 分析356例重危型蝮蛇咬伤患者人院时测定的血清钾和心电图变化.结果 356例重危型蝮蛇咬伤患者有78.09%血钾异常和82.30%心电图异常,与疾病的严重程度、疗效及预后关系密切,并影响病情变化.心电图主要表现为Q-T间期延长、ST-T改变及心律失常等,部分心肌损害严重患者,出现严重心律失常.结论 重危型蝮蛇咬伤易引起血清钾与心电图改变,病程越长中毒越重,血清钾和心电图改变也越明显,在治疗期间注意及时防治血钾异常和心肌损害等,可减少严重并发症发生.因此,患者血清钾、心电图的异常变化可作为判断病情、预后和疗效的一个重要参考指标.     

1例重危型蝮蛇咬伤患者在ICU中的护理

蝮蛇咬伤是本地区夏秋季节常见的意外伤害.其毒素为混合毒类,被咬伤后病情复杂,处理不当和延误治疗易致脏器功能损害及衰竭甚至死亡的严重后果[1].2010年9月5日我院ICU收治1例蝮蛇咬伤致呼吸、肝功能损害、急性肾衰的患者,经积极对症治疗和护理,治愈出院.现将救治护理体会报告如下.     

三种常见神经毒类毒蛇咬伤中毒的临床特征分析

目的 通过总结三种常见神经毒类毒蛇咬伤中毒患者的临床资料,为神经毒类毒蛇咬伤的诊治提供参考。方法 收集2015～2021年在广西区内救治的82例被眼镜王蛇、青环海蛇与银环蛇咬伤中毒患者的临床资料,比较三种毒蛇咬伤患者的院前急救措施、就诊时间、严重程度、临床表现、出现呼吸衰竭时间、持续使用呼吸机时间、预后等,并分析三种神经毒类毒蛇咬伤中毒的疾病特征。结果 三种毒蛇咬伤的危重型患者比较,眼镜王蛇咬伤所占比例高于青环海蛇组(83.33%、66.67%,P=0.032),青环海蛇组高于银环蛇组(66.67%、56.52%,P=0.028)。三种毒蛇咬伤的患者多器官功能障碍综合征(MODS)发生率比较,眼镜王蛇咬伤患者多器官功能障碍综合征(MODS)发生率高于青环海蛇咬伤患者(27.78%、16.67%,P=0.045),青环海蛇咬伤患者高于银环蛇咬伤患者(16.67%、6.52%,P=0.035)。三种毒蛇咬伤患者出现呼吸衰竭时间比较,眼镜王蛇咬伤患者出现呼吸衰竭时间短于青环海蛇咬伤患者[(1.53±0.52)h、(4.51±1.34)h,P=0.043)],青环海蛇咬伤患者短于银环蛇咬伤患者...     

重、危型毒蛇咬伤在EICU的观察与护理

重、危型毒蛇咬伤病情发展迅速 ,患者中毒症状严重 ,易并发呼衰、急性肾功能不全、DIC等多脏器衰竭 ,病死率极高 ,治疗和护理都有较大的困难。我科近三年来收治 1 2 0多例毒蛇咬伤的病人中有 1 4例重、危型 ,采用综合救治和护理方案 ,并注意早期各脏器功能支持治疗 ,治愈 1 1例 ( 3例因延迟送治时间而死亡 )。现将护理体会报告如下。1　临床资料1.1　一般资料　 1 4例毒蛇咬伤重、危型病人中 ,男 1 1例 ,女 3例 ,年龄 1 0～ 45岁 ,平均年龄 32岁。参照 1 990年第四届蛇伤学术会议制定的“毒蛇咬伤的临床病情分型”全部符合危重型毒蛇咬伤…     

血液灌流救治危重型毒蛇咬伤的临床护理

目的探讨血液灌流(HP)救治重型毒蛇咬伤的临床治疗和护理方法.方法采用德国生产的型号为Adsorda300C的血液灌流器、CVVH导管为重症毒蛇咬伤病人行HP救治,护士配合医生,认真做好HP术前、术中、术后的观察与护理工作.结果5例患者行HP时间为4h,均为一次性炭肾治疗成功,痊愈出院.结论HP能及时有效的清除血中毒物,治疗效果确切,疗效快.在行HP技术时,护士应充分做好准备,掌握娴熟的专科操作技术,密切观察病情变化,保持各种管道通畅,保护好穿刺部位,及时处理各种并发症,才能保证HP的顺利进行.     

222例血循毒和混合毒毒蛇咬伤患者的凝血功能分析

目的探讨血循毒和混合毒毒蛇咬伤患者凝血功能与致伤蛇种及就诊时间的相关性。方法对我院2010年7月～2012年7月收治的222例毒蛇咬伤患者的凝血功能(凝血酶原时间、活化部分凝血活酶时间、纤维蛋白原)及致伤蛇种、就诊时间进行回顾性分析。结果 (1)我院蛇伤(血循毒和混合毒)患者以竹叶青蛇、烙铁头蛇、五步蛇、眼镜蛇为常见,少数为乡城烙铁头蛇、白头蝰蛇、眼镜王蛇,其它蛇伤罕见。(2)五步蛇伤早期(6h内)容易出现凝血功能障碍。(3)除五步蛇、蝰蛇外,其它血循毒和混合毒毒蛇咬伤6h后就诊者凝血功能障碍机率高。结论我院蛇伤以竹叶青蛇、烙铁头蛇、五步蛇、眼镜蛇咬伤常见,五步蛇咬伤早期(6h内)易出现凝血功能障碍,其它血循毒、混合毒毒蛇咬伤6h后凝血功能障碍率高;早期凝血功能障碍对五步蛇咬伤有诊断参考价值。     

机械通气救治4例银环蛇咬伤急性呼吸衰竭

目的 探讨机械通气救治银环蛇咬伤致急性呼吸衰竭的治疗效果。方法 院前正确清创急救处理,及时行机械通气救治4例银环蛇咬伤致急性呼吸衰竭患者。结果 气管内插管是最佳的气道开放方法,气管插管者辅助通气4～6h后撤机及拔管可获得成功。结论 正确急救和清创,气管内插管及机械通气是救治银环蛇咬伤致急性呼吸衰竭的最有效的方法。     

毒蛇咬伤致急性呼吸衰竭38例救治分析

目的探讨毒蛇咬伤致急性呼吸衰竭的发病机制和治疗措施。方法选择毒蛇咬伤患者38例,应用抗蛇毒血清、机械通气等综合治疗。结果经综合救治措施治疗,38例全部痊愈出院。结论综合救治措施是抢救毒蛇咬伤致急性呼吸衰竭最有效的方法。     

改良敷料联合早期康复锻炼在毒蛇咬伤患者中的应用

目的探讨改良换药法联合康复锻炼在提高毒蛇咬伤患者生活质量中的应用效果。方法选择2015年1月~2016年7月我院收治的120例蛇咬伤患者为研究对象,按随机数字表法分为常规组和改良组各60例,两组均采取清创排毒、扩创排毒、局部封闭、刺络放血法、外敷双黄蛇伤散(我院自制粉末状蛇药)、全身用药等综合治疗及常规蛇伤护理措施。在此基础上,常规组予带孔透明聚乙烯胶纸敷料包扎伤口,关节处用胶布固定;改良组予弹性防水透气防渗敷料包扎伤口,辅以弹力带适当外固定,治疗后3~7天指导患者每天进行关节康复运动。两组观察时间均为7天。结果治疗期间,两组患者均无明显不良反应。治疗后,改良组患者患肢疼痛消退时间、肿胀消退时间、肢体活动功能障碍、敷料评分、换药次数及住院时间均明显少于常规组,两组比较差异有统计学意义(t=3.599、3.583、2.703、2.178、3.394、6.384,均P0.05);改良组生活质量评分显著优于常规组,差异有统计学意义(t=6.642,P0.05)。结论采用改良敷料包扎蛇伤伤口并辅以弹力带外固定,具有稳固性强、美观、灵活的优点,便于患者关节活动,且可消肿止痛,减少换药次数,提高护理质量和效率;同时联合早期康复锻炼,有助于促进关节功能康复,改善患者生活质量,缩短住院时间,减轻患者经济负担,是一种安全、有效的康复锻炼方法,值得临床推广应用。     

Use of mechanical ventilation in adults with severe asthma.

Asthma severe enough to require intubation and mechanical ventilation is associated with a mortality rate of about 10%. Therapeutic modalities are ever-changing and at times controversial. This paper provides an update on such modalities and presents, in a step-wise fashion, those most appropriate for practical patient care. The timing of intubation and the methods used to control airway patency, arterial pH and gas levels, and hemodynamic status are crucial to the success of therapy. Finally, conventional and disputed methods of bronchodilation are outlined.     

我院近十年毒蛇咬伤中毒的变化趋势分析

目的总结我院近十年毒蛇咬伤的发病情况,揭示我区毒蛇咬伤的流行病学趋势。方法收集我院2006~2015年期间收治毒蛇咬伤患者的病例资料,对其发病情况进行总结分析。结果中华眼镜蛇咬伤占首位,其次为竹叶青蛇咬伤,其他蛇类咬伤发病情况相对较少;中华眼镜蛇和竹叶青蛇咬伤的发病率呈逐年下降趋势,而其他蛇类咬伤的发病率则维持在较低水平,呈散发趋势;2015年新发印度眼镜蛇咬伤病例。结论广西境内毒蛇咬伤发病率最高为中华眼镜蛇,第二位为竹叶青蛇,但发病率均呈逐年下降趋势;新发病种印度眼镜蛇咬伤毒性高,易误诊,临床上需警惕。     

毒蛇咬伤患者院前早期程序化急救处理方案的应用观察

目的探讨毒蛇咬伤患者院前早期程序化急救处理方案的应用价值。方法回顾性分析我院58例毒蛇咬伤患者应用院前早期程序化急救处理方案的临床资料。结果 58例毒蛇咬伤患者经院前早期程序化急救处理后,痊愈出院53例,好转3例,自动出院1例,院前死亡2例（眼镜王蛇咬伤1例,银环蛇咬伤1例）。结论院前急救是蛇伤治疗前期的一个关键性步骤,院前早期程序化急救处理方案应用于蛇伤患者,有利于提高抢救成功率。     

应用抗蛇毒血清治疗毒蛇咬伤的护理

近3年来我科运用上海赛伦生物技术有限公司生产的抗蛇毒血清加本院制剂（南蛇Ⅰ号、南蛇Ⅱ号）以及外用蛇伤解毒散等药物,治疗毒蛇咬伤患者105例,效果满意。现将护理体会报道如下。     

Regional ventilation during spontaneous breathing and mechanical ventilation in dogs

We evaluated the effects of the different patterns of chest wall deformation that occur with different body positions and modes of breathing on regional lung deformation and ventilation. Using the parenchymal marker technique, we determined regional lung behavior during mechanical ventilation and spontaneous breathing in five anesthetized recumbent dogs. Regional lung behavior was related to the patterns of diaphragm motion estimated from X-ray projection images obtained at functional residual capacity (FRC) and end inspiration. Our results indicate that 1) in the prone and supine positions, FRC was larger during mechanical ventilation than during spontaneous breathing; 2) there were significant differences in the patterns of diaphragm motion and regional ventilation between mechanical ventilation and spontaneous breathing in both body positions; 3) in the supine position only, there was a vertical gradient in lung volume at FRC; 4) in both positions and for both modes of breathing, regional ventilation was nonlinearly related to changes in lobar and overall lung volumes; and 5) different patterns of diaphragm motion caused different sliding motions and differential rotations of upper and lower lobes. Our results are inconsistent with the classic model of regional ventilation, and we conclude that the distribution of ventilation is determined by a complex interaction of lung and chest wall shapes and by the motion of the lobes relative to each other, all of which help to minimize distortion of the lung parenchyma.     

Hand deformities in patients with snakebite.

Over the past 25 years, 83 patients have been treated at our hospitals for poisonous snakebites of the hand. Prior to 1970, polyvalent antivenin was used, either alone or in conjunction with cryotherapy, steroids, or incision and suction methods. Hand deformities, due to tissue necrosis, were encountered in 15 of 22 patients (68%) treated by these methods. In contrast, excisional therapy, without the use of polyvalent antivenin, was the sole method of treatment in 61 patients seen since 1970. The incidence of hand deformity in them was 8.2%. We have concluded that early excision of the envenomated tissues will not only curtail systemic toxicity from the injected venom, but will also minimize the extent of local tissue damage.     

Altered diaphragm contractile properties with controlled mechanical ventilation.

This study shows that, over time, diaphragm inactivity with controlled mechanical ventilation (CMV) decreases diaphragm force and produces myofibril damage contributing to the reduced force. We measured in vivo and in vitro diaphragm contractile and morphological properties in 30 sedated rabbits grouped (n = 6) as follows: 1 or 3 days of CMV, 1 or 3 days of 0 cmH(2)O continuous positive airway pressure, and control. The CMV rate was set sufficient to suppress diaphragm electrical activity. Compared with the control group, phrenic-stimulated maximum transdiaphragmatic pressure did not decrease with continuous positive airway pressure but decreased to 63% after 1 day of CMV and to 49% after 3 days of CMV. The in vitro tetanic force decreased to 86% after 1 day of CMV and to 44% after 3 days of CMV. After 3 days of CMV, significant myofibril damage occurred in the diaphragm but not in the soleus. The decrease in tetanic force correlated with the volume density of abnormal myofibrils. We conclude that CMV had a detrimental effect on diaphragm contractile properties.     

Pulmonary mechanics during rapid mechanical ventilation in rabbits with saline-lavaged lungs

Infants with respiratory failure are frequently mechanically ventilated at rates exceeding 60 breaths/min. We analyzed the effect of ventilatory rates of 30, 60, and 90 breaths/min (inspiratory times of 0.6, 0.3, and 0.2 s, respectively) on the pressure-flow relationships of the lungs of anesthetized paralyzed rabbits after saline lavage. Tidal volume and functional residual capacity were maintained constant. We computed effective inspiratory and expiratory resistance and compliance of the lungs by dividing changes in transpulmonary pressure into resistive and elastic components with a multiple linear regression. We found that mean pulmonary resistance was lower at higher ventilatory rates, while pulmonary compliance was independent of ventilatory rate. The transpulmonary pressure developed by the ventilator during inspiration approximated a linear ramp. Gas flow became constant and the pressure-volume relationship linear during the last portion of inspiration. Even at a ventilatory rate of 90 breaths/min, 28-56% of the tidal volume was delivered with a constant inspiratory flow. Our findings are consistent with the model of Bates et al. (J. Appl. Physiol. 58: 1840-1848, 1985), wherein the distribution of gas flow within the lungs depends predominantly on resistive factors while inspiratory flow is increasing, and on elastic factors while inspiratory flow is constant. This dynamic behavior of the surfactant-depleted lungs suggests that, even with very short inspiratory times, distribution of gas flow within the lungs is in large part determined by elastic factors. Unless the inspiratory time is further shortened, gas flow may be directed to areas of increased resistance, resulting in hyperinflation and barotrauma.