急性铊中毒5例的护理

铊是一种毒性很高的重金属元素，在地壳中广泛分布，室温下易氧化，易溶于水，其水溶液无色无味，具有极强的神经毒性与蓄积性，对胃肠道和肝肾也有损害，成人最小致死量为12mg/kg左右；急性中毒多数为非职业性中毒，多因误服或使用铊化合物的“偏方”引起，潜伏期通常为12h～24。铊中毒机制尚不完全清楚，对铊中毒患者的救治原则是脱离接触，阻断吸收以及加速排泄。据报道，口服铊中毒可用普鲁士蓝等药物处理，血液灌流能有效排除已吸收的铊。我院对收治的5例铊中毒患者采取普鲁士蓝联合血液灌流、营养神经、激素减少应激反应、利尿护肝等综合治疗，通过精心治疗和护理，症状明显好转出院，现将护理体会报告如下。     

急性铊中毒一例并文献复习

本文报道了1例急性铊中毒病例,通过文献复习,对其中毒途径、中毒机制、临床表现、诊断与治疗进行分析。本病具有以下特点:消化道是最常见途径;中毒机制可能与竞争性抑制钾离子、与巯基结合、改变脂质体的膜属性、损害线粒体功能等有关;消化道症状、周围神经病与脱发是本病典型三联征;血液净化与口服普鲁士蓝为主要解毒方法。     

急性有机磷农药中毒的治疗和护理体会

急性有机磷农药中毒是临床常见的化学药物中毒,其毒性大,可通过胃肠道、呼吸道和皮肤粘膜吸收,进入体内即分布全身,可引起机体一系列的毒性改变,甚至造成多脏器功能损害.危及患者生命.     

铊中毒五例临床分析

目的总结铊中毒的临床特点及诊治方法。方法复习５例铊中毒患者的临床资料及有关文献,分析其临床表现、铊定量结果及治疗方法、效果和预后。结果５例患者急性中毒３例,慢性中毒２例,４例有铊接触史。临床表现以周围神经、颅神经、中枢神经损害等神经系统表现多见,其次为脱发、指甲白色横纹等皮肤损害和腹痛、呕吐等消化系表现,尚可有呼吸、循环、肝肾损害等。５例均经正规驱铊治疗,除１例合并感染死亡外,余４例临床症状明显改善,复查血、尿铊正常,其中１例病程长、病情重者遗留部分后遗症。结论铊中毒的诊断依靠明确的接触史、典型的临床表现及血尿铊定量结果并不困难。由于误服含铊物质所致的铊中毒接触史常不明确,给临床诊治带来一定困难,应提高警惕     

急性有机磷农药中毒的治疗和护理体会

急性有机磷农药中毒是临床常见的化学药物中毒，其毒性大，可通过胃肠道、呼吸道和皮肤粘膜吸收，进入体内即分布全身，可引起机体一系列的毒性改变，甚至造成多脏器功能损害，危及患者生命。因此，笔者认为服药中毒抢救的关键在于熟练掌握洗胃的操作技能，提高治疗水平及护理质量及对用药过程的认真观察和出现反跳后及时抢救与护理。     

铊中毒7例救治体会

目的 探讨急性铊中毒患者的临床特点以及治疗措施.方法 回顾分析7例急性铊中毒患者的临床特点及血液灌流同多种药物联合治疗的临床资料.结果 7例中毒患者经血液灌流及普鲁士兰驱铊治疗,保肝及维持水电解质平衡等治疗,6例于住院后7 ～29 d治愈或好转出院,1例死亡.结论 急性铊中毒是临床少见和容易被忽视的疾病,尽快明确诊断、合理治疗是改善预后的重要因素.     

使铊盐排出体外的动物实验

铊盐用作杀鼠、灭虫、脱毛和止汗,曾因误服引起多例中毒;如今,放射性铊又被应用于肿瘤的扫描诊断等等方面。使铊盐排出体外已成为铊中毒治疗和医用物理学中的重要研究课题。以放射性铊作示踪剂,观察普鲁士兰(BB)等13种药物对铊在20日令鼠体内的分布、潴留和排泄的影响,判明了BB和二乙基双硫脲(DDC)是排铊的有效药物;BB     

百草枯中毒的急救措施与护理体会

目的：探讨百草枯中毒的发病机理、临床特点及有效的治疗与护理措施。方法：回顾分析15例百草枯中毒病人的临床资料。结果：毒物对组织的损害最终导致多器官功能衰竭，肺、肾、肝损伤最常见，死亡主要原因是呼吸衰竭，治疗应尽早阻止毒物吸收，清除体内已吸收的毒物和防止组织受损。结论：本病预后差，尽早洗胃、导泻、血液透析、血液灌流以增加毒物排出，保护脏器功能，加强护理，防止并发症，方可减少死亡率。     

鱼胆中毒15例临床分析

目的研究鱼胆中毒的临床特征及治疗,加深对鱼胆中毒造成各器官功能损害的认识。方法回顾分析15例鱼胆中毒的临床表现,实验室检查,并进行研究。结果鱼胆中毒可累及全身器官,受损的严重程度依次为肾、肝、心脏和胃肠道。结论鱼胆中毒主要死因为急性肾功能衰竭。早期应用肾上腺皮质激素,必要时做血液透析能改善中毒症状。     

百草枯中毒的急救与护理

目的:探讨百草枯中毒的急救和主要护理措施。方法:分析对32例百草枯中毒患者的救治,总结百草枯中毒的抢救要点、治疗方法及护理要点等。结果:百草枯中毒患者预后差,死亡率极高,必须早期采取一切行之有效的手段控制病情发展,阻止纤维化的发生。结论:早期应用洗胃、催吐、导泻、灌肠等措施阻止毒物继续吸收,输液、血液净化等措施清除体内已吸收的毒物和防止组织损伤,积极有效地综合治疗及护理是减少死亡的重要环节。     

小鼠急性铊中毒半数致死剂量的测定

目的 测定硝酸亚铊急性中毒小鼠的半数致死剂量(median lethal dose,LD50).方法 130只小鼠随机分为13组,每组10只,雌雄各半,给小鼠经口灌入不同剂量的硝酸亚铊水溶液,观察并记录2周内各组小鼠症状、毒性反应及死亡情况,观察死亡小鼠肠道的组织病理学变化.以小鼠死亡率为指标,按改良寇氏法计算其LD5...     

Analysis of Nine Cases of Acute Thallium Poisoning

In this study nine cases of thallium poisoning in a series of homicidal poisoning were analyzed in order to provide more information concerning thallium poisoning. It was found that the most common clinical feature of thallium poisoning was peripheral neuropathy and paraesthesia was more common than amyasthenia. Understanding of these clinical characteristics of thallium poisoning was helpful to early identification and differential diagnosis. Since the early administration of Prus- sian Blue, as a specific antidote for thallium poisoning, can substantially improve the prognosis, it is of great importance to establish a correct and early diagnosis.     

Ⅱ、~3H-A-OT-FU在小鼠体内的药物动力学

研究了~3H-A-OT-FU经一次灌胃后在小鼠体内的药物动力学。血中药物浓度-时间曲线符合一级吸收两室开放模型。剂量200mg/kg的分布相半衰期(t 1/2 α)为1.09小时,消除相半衰期(t 1/2 β)为64.89小时,室间转运速率常数:K_(12)为0·4341h~(-1),K_(21)为0·1714h~(-1),K_(12)/K_(21)>1。表观分布容积(Vd)为108.44ml/kg,体内清除率(CL)为1.1581ml/kg·h~(-1)。~3H-A-OT-FU在体内分布最多的器官是胃肠,以尿粪排出为主要途径。     

Multiple organ dysfunction syndrome due to ingestion of fish gall bladder

Objective To investigate changes in renal function, urine N- acetyl- β- D- glucosaminidase enzyme (N- AG), liver function, myocardial enzymes, the pathology of renal damage and the mechanism of acute renal failure (ARF) associated with fish gall bladder poisoning.Methods Eleven patients with acute fish gall bladder poisoning were consecutively admitted to our hospital from September 1997 to October 1999. Renal function, urine N- AG enzyme, liver function, and myocardial enzymes were assayed before and after treatment. One patient consented to a kidney biopsy and the pathology of renal damage was observed under light and electron microscopes.Results All patients had multiple organ dysfunction syndrome (MODS) and 11 patients suffered from ARF. Ten patients had liver dysfunction, ten patients had poisonous myocarditis, and 8 patients had gastrointestinal dysfunction. Renal function, urine N- AG enzyme, liver function, and myocardial enzymes were significantly improved after treatment compared with those of before treatment (P<0.05). Kidney biopsy showed that the main damage site was the proximal renal tubule. All eleven patients recovered and were discharged from the hospital.Conclusions Ingestion of fish gall bladder leads to kidney damage, as well as liver, heart and gastrointestinal tract injury. The mechanism of acute renal function failure is the serious tubular damage, confirming the location of kidney damage. Necrosis of the proximal tubules plays an important role in the development of ARF. Immediate hemodialysis is the most effective treatment.     

The toxicokinetics of methyl-ISP in rats

Summary The toxicokinetics of methyl-ISP was studied in rats. The logarithm of the pesticide concentration in blood versus time curve following intravenous injection was fitted to two-compartment open model. The toxicokinetic parameters are as follows: distribution half life 2 min, elimination half life 3 h, apparent volume of distribution 335.03 ml/100g, total tody clearance 1.28 ml/100g/min. After intravenous injection, the pesticide was distributed mainly in the liver and the lungs, where at subcellular level it was chiefly concentrated in nuclei and mitochondria. 66.43% of the total amount of the pesticide administered was excreted in feces and urine, especially in feces. It was easily absorbed through the gastrointestinal tract.     

有关尿液检验在临床中的应用探讨

目的分析尿液检验在临床中的运用,并对应用价值进行探讨。方法随机选择2011年1—12月在该院进行尿液检查的患者300例,通过GEB-600对患者尿液300份进行检验,检验方法采用干化学分析法,检验过程要严格根据相关规定而进行。结果对300份尿液进行检查发现,300例进行尿液检查的患者中罹患糖尿病的患者有121例,其中自述有糖尿病史的95例,慢性肾炎有36例,肾结石21例,酸中毒共有7例,黄疸7例,尿路感染28例,剩余80例为正常,80例患者中曾经患者有糖尿病的有30例,曾经患有慢性肾炎的有24例。结论有关泌尿系疾病以及肾脏等疾病可以通过尿液的检验检出,有助于疾病的及早发现,如尿结石、尿路感染等疾病的发现,同时应用于中毒的检查以及药物的监护上同样也有着十分关键的意义,在疾病临床治疗和诊断应用上值得推广。     

Oral versus Vaginal Absorption in Oestradiol in Postmenopausal Women. Effects of Different Particles Sizes

Crystalline oestradiol-17β is poorly absorbed from the gastrointestinal tract. Three different fractions and a standard fraction containing oestradiol-17β of a known particle size and surface area, were administered orally, to postmenopausal women, to test if changes in particle size will influence the absorption. The bioavailability of each fraction was determined by measurements of peripheral plasma oestrogens. Two different dosages of the standard fraction were given vaginally to compare the bioavailability after oral and vaginal administration. The gastrointestinal absorption was dependent of the particle size of oestradiol. The smaller particle the more rapid and effective absorption as reflected by increasing area under the plasma concentration curve of oestrone and oestradiol. The smallest particle, however, resulted in a pronounced initial oestradiol peak. The coarser particles were more slowly absorbed with more even plasma oestrogen elevation for a sustained period of time. The vaginal absorption of oestradiol was more effective than the gastrointestinal. When the same amount of an equal preparation according to particle size, was given vaginally the maximal plasma concentration was almost 40 times higher than when given orally.     

血浆置换在急性白毒伞中毒性脑病中的临床应用价值分析

目的分析血浆置换清除毒肽的效果,以及毒肽能否穿透血脑屏障损害神经系统。初步明确白毒伞中毒患者中毒性脑病的发病机制和血浆置换的治疗机制。方法收集2007～2012年临床确诊的急性白毒伞中毒病例40例,应用高效液相色谱技术检测临床病例血浆置换前后血液、尿液、脑脊液以及血浆置换废液中α-鹅膏毒肽、鬼比毒肽的浓度,并同期进行肝肾功能等相关检查。结果治疗后血液、脑脊液中α-鹅膏毒肽浓度均低于治疗前,且第二疗程低于第一疗程,差异有统计学有意义(P<0.05);肝肾功能以及心肌酶谱等指标均明显低于治疗前(P<0.05),且第二疗程低于第一疗程(P<0.05)。结论血浆置换能有效降低急性白毒伞中毒后血液以及脑脊液中毒肽的浓度,保障患者生命安全,是治疗中毒性脑病的急救措施。     

Thallium poisoning: emphasis on early diagnosis and response to haemodialysis

Thallium poisoning is known for its diverse manifestations and these can delay the diagnosis if a clear history of poisoning is not forthcoming. A 42 year old man presented on the third day of illness with flaccid quadriparesis and paresthesia, which were confused with Guillain-Barré syndrome. Because of associated loose motions, skin lesions, and liver and kidney dysfunction arsenic poisoning was considered. In the second week he developed ophthalmoplegia, nystagmus, and neck tremor and later developed alopecia, and thallium poisoning was suspected. His serum thallium level on the 18th day of illness was 40 980 micro g/ml. He was subjected to haemodialysis, potassium supplementation, laxatives, and B complex supplementation. He showed significant improvement after haemodialysis and at three months he was able to walk with support. At six months of follow up he was independent for activities of daily living. Severe paresthesia, ophthalmoplegia, cerebellar and extrapyramidal signs, and alopecia are highly suggestive of thallium poisoning. Haemodialysis may be effective even in the third week of poisoning.