急性高效氯氟氰菊酯农药中毒的诊治体会

目的:探讨高效氯氟氰菊酯农药中毒的有效抢救措施.方法:对我院17例高效氯氟氰菊酯农药中毒的患者抢救经验进行总结分析.结果:本组17例中,16例痊愈.另1例因家庭经济困难,放弃治疗.结论:有效预防、早期治疗、合理用药是治疗高效氯氟氰菊酯农药中毒的关键.     

农药中毒患者治疗前后胆碱酯酶的变化分析

目的探讨农药中毒患者采用血液透析治疗前后胆碱酯酶的变化。方法农药中毒患者16例根据治疗方法的不同分为治疗组与对照组各8例，对照组采用传统方法治疗，治疗组在此基础上采用了血液灌流治疗。结果治疗组的生存率为100．0％，对照组的生存率为75．0％，组间对比有明显差异（P〈O．05）。两组治疗前血清胆碱酯酶活力对比无明显差异，哥治疗后存活者的组间与组内对比有明显差异（P〈O．05）。治疗组存活者住院时间明显高高于对照组（P〈0．05）。结论农药中毒患者采用血液灌注治疗能取得很好的预后效果，其疗效的发挥可能与恢复胆碱酯酶活力有关。     

长托宁对有机磷中毒伴中枢神经系统损害的疗效观察

目的分析长托宁在急性有机磷农药中毒伴中枢神经系统损害中的应用疗效。方法选择应用长托宁治疗的重度急性有机磷农药中毒伴中枢神经系统损害患者48例作为治疗组,并将过去使用阿托品治疗的重度有机磷农药中毒伴神经系统损害的43例既往病例作为对照组进行对比,比较两组的中毒症状持续时间、不良反应、胆碱酶活力恢复情况及治愈率。结果治疗组较对照组M样症状及中枢神经症状消失时间明显缩短,平均用药次数及用药量明显减少,并发症发生率与病死率明显降低。结论长托宁治疗重度有机磷农药中毒伴中枢神经系统损害较阿托品疗效好,不良反应发生率低。     

Developments in extracorporeal therapy for the poisoned patient

The modern use of extracorporeal therapies to treat poisoning and drug overdoses dates back to the early 20th century and has evolved along with their use as treatment for acute kidney injury or as maintenance therapy in advanced kidney disease. As our understanding of drug pharmacokinetics and membrane materials has increased, the technologies of extracorporeal therapy and their applications have become more sophisticated. Despite that, there is little robust evidence to guide clinicians on the optimal use of extracorporeal therapy in treating poisoning beyond case reports and series. New efforts are underway to remedy that: the Extracorporeal Treatments in Poisoning Workgroup (EXTRIP) is an international effort on the part of nephrologists, pharmacists and toxicologists to review the available data and formulate evidence-based guidelines on how to use extracorporeal techniques to treat poisoning and improve patient outcomes. Meanwhile, new techniques and membranes are under development. This review will summarize those key scientific and technologic developments, the efforts to optimize their use and new directions in research.     

Diazepam in the treatment of organophosphorus ester pesticide poisoning

Although the main site of action of diazepam, as with other benzodiazepines, is at the gamma-aminobutyric acid A (GABAA) receptor, the degree to which the beneficial actions of diazepam in organophosphorus (OP) ester pesticide poisoning are mediated through the GABAA receptor has been a matter of controversy. Although in most series of OP intoxications, convulsions have been relatively uncommon, it is probable that convulsions produce long-term sequelae in the central nervous system by causing structural damage. Animal studies have demonstrated that diazepam prevents and treats convulsions produced by OPs and may prevent the late effects caused by damage to the central nervous system induced by such convulsions. Consequently, the use of diazepam is an important part of the treatment regimen of severe OP poisoning as it prevents, or at least reduces the duration of, convulsions. In addition, case reports suggest that diazepam will also ameliorate muscle fasciculation, a subjectively unpleasant feature of OP pesticide poisoning. There are no data, either experimental or clinical, demonstrating any clear effect of diazepam alone on lethality in OP poisoning. In fact, in one study of large animals, diazepam, given alone, increased lethality. In animals experimentally poisoned with OPs, combined treatment with atropine and diazepam significantly lowered lethality compared with atropine treatment alone, indicating a clear beneficial effect. There are numerous case reports of the use of diazepam, generally as an adjunct to other more specific OP antidotes such as atropine and/or pyridinium oximes. Based on this evidence and pharmacodynamic studies in experimental animals, diazepam should be given to patients poisoned with OPs whenever convulsions or pronounced muscle fasciculation are present. In severe poisoning, diazepam administration should be considered even before these complications develop. Although diazepam has a large therapeutic index, there appears to be no place for its routine use in OP poisoning. Diazepam should be given intravenously to patients treated in hospital for OP poisoning, although the intramuscular route is used to administer diazepam outside hospital, such as on the battlefield, when an auto-injector is employed. It should be recognised, however, that absorption by the intramuscular route is poor.     

Public Health Department Response to Mercury Poisoning: The Importance of Biomarkers and Risks and Benefits Analysis for Chelation Therapy

Chelation therapy is often used to treat mercury poisoning. Public health personnel are often asked about mercury toxicity and its treatment. This paper provides a public health department response to use of a mercury-containing cosmetic in Minnesota, a perspective on two unpublished cases of chelation treatment for postulated mercury toxicity, and comments on the use of a nonsystemic treatment for removal of mercury following the Iraqi seed coat poisoning incident. Physicians should evaluate sources of exposure, biomarkers, and risks and benefits before recommending chelation therapy for their patients. Potential risks to chelation therapy and its little understood subtle or latent effects are areas of public health concern.     

纳络酮抢救急性中毒患者的效果及对患者清醒时间的影响

目的：探讨纳络酮在各种急性中毒患者抢救中的临床效果。方法：回顾性分析我院急诊科2009年10月~2012年10月收治的320例急性中毒患者的病例资料,其中急性乙醇中毒125例、急性一氧化碳中毒137例、急性安眠药中毒30例、急性有机磷中毒28例。观察组选择采用纳络酮治疗的165例患者,对照组为采用常规治疗的155例患者,对比两组患者临床效果、清醒时间及不良反应发生情况。结果：观察组临床效果显著优于对照组,清醒时间较对照组有明显缩短,两组差异有统计学意义（P〈0.05）;两组患者用药过程中均未见明显不良反应发生。结论：纳络酮应用于乙醇、一氧化碳、安眠药、有机磷等急性中毒患者有较好的临床效果,值得在临床上推广使用。     

长托宁与阿托品治疗急性有机磷农药中毒的疗效对比分析

目的比较长托宁与阿托品治疗急性有机磷农药中毒(acute organophosphorus pesticide poisoning,AOPP)的临床效果和可行性。方法将2005-2009年收治的应用阿托品治疗的有机磷农药中毒65例作为阿托品组,将2007-2011年收治的应用长托宁治疗的有机磷农药中毒65例作为长托宁组。2组均给予一般治疗和使用胆碱酯酶(ChE)复能剂,阿托品组在此基础上单用阿托品治疗,长托宁组轻、中度中毒患者单用长托宁治疗,重度中毒患者采用长托宁与阿托品联合疗法。观察2组阿托品或长托宁化时间、ChE恢复时间、住院时间、阿托品中毒、并发症发生和病死率。结果 2组阿托品或长托宁化时间、ChE恢复时间相同中毒程度比较差异无统计学意义(P>0.05),但阿托品组重度中毒者住院时间长于长托宁组(P<0.05),轻度和中度中毒2组住院时间比较差异无统计学意义(P>0.05)。阿托品组重度中毒患者阿托品中毒、并发症发生率及病死率均高于长托宁组,差异有统计学意义(P<0.05,P<0.01)。结论长托宁可明显减少阿托品中毒和并发症发生率,降低病死率,缩短住院天数,使用安全可靠,可作为救治AOPP的首选抗胆碱药物。     

临床药师参与1例儿童苯妥英钠中毒诊治

目的:探讨临床药师在参与小儿药物中毒诊治中发挥的作用。方法:介绍临床药师在参与1例儿童苯妥英钠中毒诊治过程中的做法。结果:临床药师通过采用高效液相色谱法分析药物成分,检测中毒患儿的血药浓度,建议停用苯妥英钠换用丙戊酸钠,为临床医师明确诊断提供了依据。结果:经停药后患儿的临床症状消失。结论:临床药师可运用治疗药物监测技术,在小儿药物中毒诊治方面开展临床药学服务,体现临床药师的价值和作用。     

拟除虫菊酯类杀虫药急性中毒56例临床分析

目的探讨拟除虫菊酯类杀虫药急性中毒的临床表现及诊治经验。方法对56例急性拟除虫菊酯类杀虫药中毒的临床资料进行回顾性分析。结果急性拟除虫菊酯类杀虫药中毒涉及多个系统,其中以神经系统和消化系统症状为主要表现,症状随积极治疗及病情的好转而消失。结论通过认识急性拟除虫菊酯类杀虫药中毒的临床表现,有助于正确的诊断和治疗。     

血液灌流串联血液透析救治急性百草枯中毒的临床研究

目的研究血液灌流串联血液透析治疗急性百草枯中毒的临床效果。方法临床按照不同中毒剂量区别治疗,分别分为治疗组：常规治疗＋HP串联HD;对照组：单纯常规治疗。结果不同中毒剂量的治疗组与对照组死亡率不同,死亡患者中的存活时间治疗组较对照组长（P〈0．05）。结论急性百草枯中毒服毒量越大死亡率越高（P〈0．05）,服毒量≤100ml中毒患者HP串联HD治疗可明显降低死亡率（P〈0．05）,临床可以使用血液灌流串联血液透析治疗百草枯中毒的患者,提高患者存活率。     

Oxime-type acetylcholinesterase reactivators in pregnancy: an overview

Oxime-type acetylcholinesterase reactivators (oxime-AChER) are used as an adjunct in the treatment for organophosphorus anticholinesterase poisoning. Because of the widespread usage and exposure of organophosphorus compounds (OPCs), its poisoning and fatalities is obvious in pregnant women, embryos and fetuses. OPCs irreversibly inhibit acetylcholinesterase (AChE) at nerve synapses. Furthermore, the role of AChE other than neurotransmission termination has been defined in the literature. The growing evidences show that cholinergic mechanisms are involved during growth and development of other organ systems. In contrary to the fact, the data on the use of oxime-AChER in OPC poisoning in pregnancy are scanty. The present review aimed to comprehend the status of oximes in pregnancy in lieu of the published literature. A thorough literature search was performed in January 2013, using ten popular search engines including Medline/PubMed, Google scholar, etc., using nine standard keywords. The search period was set from 1966 to present. The search did not reveal substantial data. No considerable studies were retrieved which could really demonstrate either the beneficial, harmful or even null effect of oxime-AChER usage in pregnancy. Only eighteen relevant articles were obtained for a period of about 47 years. In the literature, there is no report available to demonstrate the risk of using oxime-AChER in pregnancy for the treatment of OPC poisoning. The study reveals that the use of oxime-AChER in pregnancy is largely un-addressed, inconclusive and based on speculation albeit the incidences of OPC poisoning are quite prevalent. Well-designed studies are warranted for a tangible conclusion.     

临床药师在朱砂外用致汞中毒诊治中的作用

目的：探讨临床药师在药物致中毒诊治中的作用。方法：在外用朱砂致汞中毒患者救治中,临床药师结合患者症状和用药史,为医师提供朱砂成分信息,并提出检查尿汞浓度的建议,为及早诊断提供依据,诊断明确后参与治疗方案的设计并开展用药监护。结果：急查患者尿汞浓度超标,经驱汞、保肝等治疗后,尿汞浓度降至正常,病情明显好转。结论：临床药师能够在药物中毒救治中提供药品信息、参与制定药物治疗方案和开展药学监护。     

Acute digoxin poisonings: review of therapy.

Acute digoxin poisoning, its recognition and management, are reviewed. The uses of syrup of ipecac, gastric lavage, activated charcoal, cholestyramine, colestipol, edetate sodium and cathartics as measures to terminate the drug exposure are discussed. Measures to hasten digoxin elimination, such as the use of furosemide, hemodialysis and digoxin-specific antibodies are reviewed. Supportive management may include treatment with atropine, phenytoin, lidocaine, propranolol, glucose, insulin and sodium polystyrene sulfonate. Proper management of digoxin poisoning involves the use of standard decontamination procedures (emesis or gastric lavage). Activated charcoal is strongly recommended, followed by rapidly acting cathartics. Antiarrhythmic therapy usually involves atropine sulfate and phenytoin sodium.     

甲氯酚酯治疗儿童急性重度有机磷中毒疗效观察

目的：探讨甲氯酚酯用于儿童急性有机磷农药中毒的临床治疗效果。方法：将近10年我科收治的急性有机磷农药中毒患儿58例,随机分为治疗组30例（女10例）,对照组28例（女9例）,对照组采用洗胃、静脉推注阿托品、解磷定、吸氧、保持呼吸道通畅等常规方法。治疗组在常规治疗的基础上静脉滴注甲氯酚酯（剂量60～100mg/次,2次,d）观察两组儿童的治疗效果。结果：治疗组治愈26例,治愈率86．7％;对照组治愈19例,治愈率67．9％两组比较P〈O．05。结论：在抢救重度有机磷农药中毒时,及时应用甲氯酚酯能明显提高抢救成功率,值得临床推广使用。     

160例急性中毒患者流行病学调查

目的:回顾分析近3年来某院160例急性中毒患者的流行病学资料,为今后本地区急性中毒防治提供依据。方法:对某院2008年4月~2010年4月收治住院的160例急性中毒资料进行多因素分析。结果:本组160例患者中,男性多于女性,中毒年龄以中青年(18~59岁)居多,患者以有机磷中毒为最多见(20.6%)。其次,男性患者以酒精中毒为主,女性以安定中毒为主(分别为5.625%和6.875%)。中毒患者以农民、民工及低收入人群居多。中毒事件以第3季度高发。农药百草枯死亡率最高(80%),食物中毒治愈率最高(43.75%)。结论:某院急性中毒患者以中青年最多,有机磷中毒比例最高。其次,男性患者以酒精中毒为主,女性以安定中毒为主。应特别加强农村、郊县地区及低收入人群安全卫生教育,关注弱势群体,提高全民素质是防治中毒的关键。     

Interest in an glutamate antagonistic compound for the treatment of organophosphate poisoning

Classical emergency treatment of organophosphate poisoning includes the combined administration of a cholinesterase reactivator (an oxime), a muscarinic cholinergic receptor antagonist (atropine) and a benzodiazepine anticonvulsant (diazepam). In subjects taking pyridostigmine and trained to autoadminister at least one autoinjector at the first signs of poisoning, classical emergency treatment ensures survival but only an antiglutamatergic compound like gacyclidine appears to be able to ensure optimal management of nerve agent poisoning in terms of rapid normalization of EEG activity, clinical recovery and total neuroprotection. All of this reinforces the therapeutical value of gacyclidine, which is in the process of approval for human use in France for treatment of head injury, as a central nervous system protective agent for the treatment of OP poisoning.     

汞中毒相关膜性肾病的临床治疗并文献复习

目的：探讨汞中毒相关膜性肾病的治疗方法,为临床提供参考。方法：经查阅相关文献,对汞中毒相关膜性肾病患者的临床表现、肾脏病理特点、治疗预后等进行总结,并对我院2012年12月收治的1例因使用含汞药物导致汞中毒相关膜性肾病患者的实际情况进行分析。结果：文献报道的52例汞中毒引起的肾病病例中,男性14例,女性38例;年龄最小15岁,最大53岁;外用及内服含汞物质3周～6年;37例行肾活检,以膜性肾病为主（33例）;33例膜性肾病患者均给予驱汞治疗及对症支持治疗,其中联合激素治疗者11例,均未使用免疫抑制剂,多数患者经驱汞治疗3～4个疗程临床症状缓解,完全缓解时间小于7个月。我科收治1例36岁男性患者,院外服用含汞中药秘方药丸80 d,肾脏病理表现为膜性肾病Ⅰ期,患者未使用激素及免疫抑制剂,驱汞治疗效果较好。结论：应提高对汞中毒相关膜性肾病的认识,及时行驱汞治疗,预后较好。     

Cardiac rhythm in tricyclic antidepressant poisoning.

One hundred adult patients with tricyclic antidepressant poisoning were studied by clinical observation and EKG monitoring. Sinus tachycardia was common but dysrhythmias were uncommon and unimportant. EKG monitoring did not influence the treatment of these patients and the value of its routine use in tricyclic antidepressant poisoning is questioned.     

血液灌流对急性重度有机磷中毒的疗效观察

目的 观察血液灌流对急性重度有机磷农药中毒患者血液胆碱酯酶活性的影响,从而判断血液灌流的疗效.方法 选择2007年9月至2011年10月在我院急诊入院的急性重度有机磷农药中毒患者52例,其中未同意血液灌流者20例作为对照组,同意血液灌流者32例作为治疗组,比较分析两组患者血液胆碱酯酶浓度变化.结果 治疗组患者血液灌流前后血液胆碱酯酶浓度明显升高.结论 血液灌流对急性重度有机磷中毒效果显著,宜尽早使用.