梅州地区急性中毒患者原因调查分析及应对策略

目的:调查和分析梅州地区急性中毒原因与流行病学特点,提出应对策略。方法:采用回顾性研究方法,对2012-2014年本院收治的急性中毒患者的性别、年龄、职业、发生时间、发生地点、中毒原因、患者来源、毒物种类、中毒物质名称、毒物侵入途径、急诊诊断、去向及转归等项目进行调查统计分析。结果:2012-2014年本院急诊科室收治559例急性中毒患者,男230例,女329例,女性多于男性。平均年龄(38.7±5.9)岁,主要集中于21~40岁。中毒患者直接来本院就诊448例(80.1%),由外院转诊111例(19.9%),农村患者多于城镇患者。急性中毒患者职业以农民、民工和待业人员居多。中毒时间集中于1~2月、5~6月和11~12月。中毒途径中口服中毒比较常见,占67.5%。自杀是中毒的主要原因,因家庭纠纷、恋爱婚姻等问题自杀的患者较集中。主要毒物为有机磷农药、一氧化碳和酒精。有机磷农药与镇静催眠药中毒患者,女性病例数明显多于男性。酒精中毒患者,男性病例数显著多于女性。559例急诊中毒患者,痊愈出院462例(82.6%),病情好转出院78例(14.0%),死亡19例(3.4%)。结论:根据本地区急性中毒的流行病学特点,制定应对策略,从而降低中毒发生率及致残率,减轻患者的经济负担,创造良好的社会效益。     

3793例急性中毒患者的临床分析

目的了解综合性医院急性中毒病人的特点。方法采用回顾性方法对近五年时间中到本院急诊科就诊的所有急性中毒病人进行分析。结果五年共收治急性中毒患者3793例,占同期急诊病人的0.88%。20~49岁为急性中毒的高发人群占80%以上,男性多于女性,居前三位的急性中毒分别为:乙醇中毒(56.66%)、药物类中毒(18.80%)、食物中毒(10.97%)。主要的治疗方法为对症支持治疗,急诊治愈率为95.62%,需要住院进一步治疗者占3.11%,急诊病死率为0.71%。结论急性中毒的年龄、性别、中毒种类、治疗方法、疾病转归有其自身的特点,掌握这些特点能更好地为急性中毒的防治提供帮助。     

2556例急性中毒病例临床资料分析

目的了解急性中毒患者的临床特点。方法对2009年1月-2011年1月间我院及我区其它7家综合性医院急诊科诊治的急性中毒患者的性别、年龄、职业、发生时间、发生地点、中毒原因、患者来源、毒物种类、中毒物质名称、毒物侵入途径、诊断及转归等进行调查统计分析。结果在2556例急性中毒患者中,中毒的年龄主要集中于20~29岁（占38.75%）。男女比为1∶1.15。中毒患者职业排位分别是农民工、个体开业、家务及待业人员、工人。52.86%的中毒发生在家里。就诊时间〉1 h者占67.05%。毒物进入人体最常见的途径是经消化道摄入（73.78%）。前6位的中毒原因依次是酒精、一氧化碳、镇静催眠药、有机磷农药、鼠药、食物。第一位死因是一氧化碳中毒。99.09%的患者治愈或好转,病死率为0.91%。结论急性中毒仍严重危害着我区人民群众的健康,应根据我区急性中毒患者的流行病学特点进一步加强对中毒的管理、干预和有效预防。     

综合性基层医院急性中毒的发病特点

目的：研究综合性基层医院急性中毒患者的发病特点。方法：采用前瞻性研究方法，对2007年1月～2007年12月在急诊科就诊的急性中毒患者的性别、年龄、职业、中毒时间、中毒原因、毒物种类、中毒途径、急诊诊断、急诊处治情况、转归等进行调查分析。结果：急性中毒患者共534例，占急诊患者总数4．12％，男女比为1：1．02，主要集中于30～39年龄组（占24．7％），毒物种类以农药为主（34．6％），其他依次为药物、酒精、一氧化碳、食物、其他化学物质等：中毒时间呈无规律性波动，以1～2月、8月、12月相对较多，毒物进入人体最常见的途径是经消化道摄入（占80．6％），中毒患者的职业以农民为主（占36．1％），其他依次为城镇居民、个体从业者、无业人员、学生等，94．6％患者治愈出院，3．4％死亡。结论：青年人与农民是县级市急性中毒的高危人群，毒物种类以农药、药物、酒精、一氧化碳、食物和其他化学物质为主，中毒途径主要为消化道摄入，中毒季节无明显规律性。     

3772例急性中毒注册病例流行病学研究报告

目的：通过急性中毒注册登记表收集的信息资料,研究综合性医院急诊科急性中毒患者诊疗结果、急性中毒流行病学特征,为提高本地区急性中毒诊治水平、制定综合防治措施提供科学依据。方法：设计急性中毒注册登记表．对1998年1月至2012年12月在海南省人民医院急诊科就诊的急性中毒患者进行登记,收集并分析患者性别、年龄、职业、中毒原因、毒物种类、毒物接触途径、毒（药）物鉴定与否、处理措施、预后等信息。结果：3772例急性中毒病例以治疗药物急性中毒为第一中毒类别;21-45岁为第一位高发年龄组（61．00％）;学生为第一位职业类别（21．97％）;女性多于男性;中毒途径以消化道摄入为第一位（87．38％）;毒物鉴定率仅7．34％。结论：急性中毒的预防及其心理教育与咨询重点应在21～45岁的女性以及学生、商界人士群体：政府需加大对镇静催眠类药物及其处方的监管力度;本地区对中毒毒物的鉴定有待加强与提高。     

315例急性中毒患者的救治体会

目的通过分析315例急性中毒患者临床资料，旨在总结急性中毒的救治经验。方法收集我院2005年1月～2006年12月在急诊科就诊的急性中毒患者的性别、年龄、发生时间、中毒原因、毒物种类、毒物侵入途径、急诊诊断、急诊处理情况、转归等资料并进行分析。结果急性中毒患者共315例，占急诊患者总数的2．33％o，男女比为1：0．84，年龄主要集中于20～29岁年龄组（占35．9％）；毒物种类以酒精为主（占38．4％），其他依次为药物、食物、其他化学物质、农药中毒等；中毒时间呈无规律性波动；毒物进入人体最常见的途径是经消化道摄入（占85．1％）；中毒原因有自杀意念者占39．0％，其余为误食、误吸等：98．1％患者治愈出院，1．9％死亡。结论迅速明确诊断是中毒抢救的基础，维持呼吸和循环的稳定、立即终止接触毒物、清除尚未吸收的毒物和促进体内毒物的排泄是救治成功的关键，保护重要器官功能是治疗的重点。     

张掖市老年人急性中毒的调查

目的调查甘肃张掖市老年人急性中毒的流行病学特点。方法采用回顾性研究方法,对1996年1月—2005年12月间所有到张掖市人民医院就诊的年龄≥60岁急性中毒的579例患者和抽取同期873例年龄＜60岁急性中毒患者进行了调查,项目包括：中毒原因、毒物种类、接触毒物时间、接触途．径、就诊时状态、治疗经过及转归等。结果老年患者中发生急性中毒的男女比例为1：1 73,农业人口急性中毒是非农业人口的3．45倍；农业、非农业人口老年患者就诊时间分别为19．9±1．7、7．6±1．2 h,经口摄入毒物者非农业、农业人口分别占69．7%和51．1%。镇静催眠类药物是非农业人口老年患者中毒的主要毒物,占40．5%,农业人口老年患者中毒以农药和灭鼠药为主,占49．2%。结论甘肃张掖市急性中毒的老年患者中农业人口急性中毒的发病率高于非农业人口,女性多于男性。     

急诊中毒病例流行病学统计分析

目的统计分析某院近年急诊中毒病例情况,探讨急性中毒病例的疾病谱分布与特点。方法收集某院2017年1月至2018年12月急诊收治的中毒患者200例作为本次研究对象,对各患者临床资料展开回顾性分析,探讨中毒患者疾病谱分布与发病特点,回归分析急诊中毒危险因素。结果研究纳入200例中毒患者包括男性患者134例(67.00%)、女性患者66例(33.00%);中毒患者中,年龄40-49岁患者、年龄30-39岁患者占比较高,相比其他年龄组患者占比明显更多(P0.05);患者职业中,农民构成比最高,其次为外来务工人员与无业人员;患者中毒类型中,酒精中毒占比最高,其次为药物中毒;中毒途径分析显示,毒性物质消化道吸收为主要中毒途径;纳入患者以冬季中毒占比最高;对数据进行Logistic多因素回归分析显示,患者年龄、职业是急诊中毒危险因素(P0.05)。结论急性中毒救治是急诊科的一项重要工作,不同地区的毒性物质种类、特点不同,分析此类患者流行病学特征有助于对患者的中毒种类做出判断,指导救治过程与未来急诊医疗设施建设方向。     

我国急性中毒流行病学现状分析

目的研究我国急性中毒的流行病学特点,为今后制定急性中毒控制规划提供依据。方法通过广泛的文献检索和搜集,采用荟萃(Meta)分析,对我国1994年1月至2007年9月中国医院知识库发表的研究急诊科急性中毒临床流行病学调查结果进行汇总、归纳和统计分析。结果共检索到文献714篇,其中24篇进入Meta分析。总计报告急性中毒27908例;男女比例为1∶1.31。急性中毒患者中,20~29岁占40.28%,30~39岁占21.05%。患者主要为农民(占20.24%),其他职业依次为待业(占19.82%)、员工(占16.87%)、学生(占13.87%)。毒物种类以药物(26.49%)、乙醇(22.80%)、一氧化碳(14.94%)、食物(10.90%)、农药(10.71%)为主。自杀是常见的中毒原因(占57.87%),80.77%为口服中毒,74.27%在家中中毒。急性中毒病死率为2.06%,死亡患者中毒毒种以农药(26.74%)、毒蘑菇(12.30%)为主。结论本报告提供了近期我国急诊科急性中毒的流行病学模式,为今后国家制定急性中毒治疗预防措施提供参考依据。     

210例小儿急性中毒临床分析

目的对210例小儿急性中毒进行总结,分析临床特点。方法回顾性分析210例小儿急性中毒的中毒年龄、原因、途径及毒物种类,治疗与转归。结果发病年龄在40 d～14岁之间,1～3岁幼儿发病率最高,占57.6%(121/210),其次4～7岁占24.3%(51/210)。主要中毒原因为误服,毒物以药物为主,占41.9%(88/210),其次是农药38.1%(80/210),仅次于药物。农村发病率为94.3%(198/210)远高于城市,男孩占69.0%(145/210),明显多于女孩。结论210例小儿急性中毒以幼儿、学龄前儿童为主,误服是中毒的主要原因。农村是预防的重点,加强小儿和农药的管理对预防小儿急性中毒有重要的意义。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.