麻果中毒40例临床分析

目的:观察麻果中毒的临床表现,治疗效果和预后。方法:对2009年9月—2010年5月期间因麻果中毒而来我科就诊的40例患者的临床资料进行回顾性分析。结果:吸毒者年龄15～45岁,主要集中在20～35岁;男性28例,占70%,女性12例,占30%。吸毒方式为鼻吸和口服;中毒表现,以神经系统症状、心脏损害及消化道症状为主;治愈31例,无明显改善者9例,治愈率77.5%。结论:麻果中毒者以青年男性居多,临床表现以神经系统,心血管系统损害及消化道症状为主;治疗以祛除毒源、综合对症治疗为主,纳洛酮治疗有效。     

Evaluation of cosmetic product exposures reported to the Milan Poison Control Centre,Italy from 2005 to 2010

Introduction. To the average consumer, “cosmetics” are not considered to cause damage to human health under normal conditions of use. Thus, cosmetic “safety” does not require any particular attention to the possibility that cosmetics may result in a toxic exposure, especially for children. Poison Control Centres (PCCs) provide specialized and rapid information for consumers and health professionals to ensure management of events related to the exposures to different agents, including Cosmetics. Poison Control Centres also represent a unique source of information to investigate the frequency and type of exposures to cosmetic and the related risks. Objective. An analysis of cases concerning human exposures to cosmetics collected from 2005 to 2010 by the PCC at the Ospedale Niguarda Ca’ Granda (Milan, Italy) was performed. Results. During this period, 11 322 human exposure cases related to cosmetics were collected accounting for 4.5% of the total human clinical cases. Almost, all the requests for assistance came from consumers (53%) and hospitals (40%). The most frequently reported site of exposure was the consumer's own residence (94%). The exposures mainly involved children younger than 4 years (77%). No difference in gender distribution was observed (female 49%, male 51%). Almost, all of the exposures were unintentional (94%). Intentional exposures, mainly related to suicide attempts and accounted for 6% of cases involving persons aged more than 12 years. Personal hygiene products (30%), perfumes and hair care products (excluding hair dyes) (both 13%) were the most frequently involved categories. Symptoms were present only in 26% of the exposures and were mostly gastrointestinal (46%). Most of the cases were managed at home (43%) whereas hospital intervention was required in 38%. Conclusion. Since the exposure frequency seems more likely to reflect product availability and accessibility to ingestors, our results call for closer attention to this type of hazard, especially for children younger than 4 years of age.     

Preserving the United States’s Poison Control System

The funding of United States’s poison control centers is threatened. The following Commentary argues for support of the current outstanding poison control system by presenting the evidence for its cost-effectiveness.     

酚类灼伤所致中毒的临床研究

目的：探索酚类灼伤所致酶中毒的影响因素及酚中毒的临床特点，方法：收集并筛选本院近25年酚类灼伤的病例，重点对灼面积、部位、尿液颜色、尿酚含量与酚中毒的关系进行统计学分析。结果：酚中毒及各脏器损害的发生率的尿酚异常率，随灼伤面积增大而增高（P＜0．05－0．01），且在面颈部灼伤者中发生率显著增高（P＜0．05）。酚中毒的临床特点为肾脏是靶器官，中枢神经系统，溶血及心脏损害发生率高，且均为早期表现，肝脏的急性影响相对较少。结论：导致酚中毒的影响因素主要是灼伤面积，部位及创面的早期处理，酚类灼伤可导致多脏器功能障碍综合征，发生时间大多在24－48h内。     

雪卡毒素中毒的诊断与检测

目的:探讨雪卡毒素中毒的诊断与检测方法,为临床及时治疗提供依据。方法:对一起苏眉鱼中毒的26例患者进行临床资料分析并用进口试剂盒检测其标本。结果:26人中除1人雪卡毒素阴性外,外其余25人均检出阳性。阳性率为96.15%。WBC<10.0×109/L有19例占73.08%,10.0×109/L15.0×109/L有2例,血清K <3.5mmol/L有3例,26例尿常规、肝肾功能、心肌酶谱及血胆碱酯酶均正常,大便培养示发现霍乱弧菌、志贺菌及沙门氏菌。结论:雪卡毒素检测具有高特异性,可尽早诊断及时治疗,最大程度上减少对患者的危害性。     

血液灌流联合洗胃导泻治疗重度有机磷农药中毒

目的研究血液灌流联合洗胃、导泻治疗急性重度有机磷农药中毒的效果。方法回顾性分析自2003年7月至2006年6月重度有机磷农药中毒病历资料完整的72例临床资料。全部病例均在急诊科洗胃及内科常规处理后转入ICU并给予血液灌流治疗，将内科常规治疗、血液灌流同时再次反复洗胃、导泻的34例作为治疗组，将仅内科常规治疗、血液灌流，未再次洗胃、导泻的38例作为对照组。结果治疗组治疗开始至清醒时间，氯磷定、阿托品用量，住院时间均较对照组明显减少，治愈率提高，两组比较差异有统计学意义。结论内科常规治疗加早期血液灌流治疗急性重度有机磷农药中毒安全有效，早期血液灌流同时反复洗胃、导泻，可以进一步提高治愈率。     

氟乙酰胺中毒血镁检测及临床意义

目的:探讨氟乙酰胺中毒患儿血镁浓度的变化与其临床价值.方法:将35例氟乙酰胺中毒患儿根据中毒程度分为轻、中、重三组,在其入院24 h内,抽静脉血3 mL进行血镁浓度测定,并与100例正常体检儿的血镁浓度进行比较.结果:氟乙酰胺中毒后血清镁离子水平下降,其下降幅度与中毒程度呈正相关,轻度中毒组与对照组比较差异无统计学意义(P＞0.05),中重度中毒组与对照组比较差异有统计学意义(P＜0.05).结论:硫酸镁对于治疗氟乙酰胺中毒有一定的潜在意义.     

血必净注射液治疗急性百草枯中毒的实验

目的探讨血必净注射液对急性百草枯大鼠中毒脏器损害的治疗保护机制。方法成年Wistar大鼠随机分为百草枯250 mg/kg剂量染毒对照组、百草枯250 mg/kg剂量染毒 血必静注射液高剂量治疗组(1.72 g生药/kg)、百草枯250 mg/kg剂量染毒 血必静注射液低剂量治疗组(0.86 g生药/kg)3组。取原液加蒸馏水稀释至1 ml灌胃染毒。治疗组于染毒后1 h经鼠尾静脉给予相应剂量的血必静注射液缓慢注射,观察染毒组和治疗组动物表现。染毒8 h后处死动物,留取动静脉血及大鼠肺组织,行动脉血气分析、丙氨酸转氨酶(ALT)、碱性磷酸酶(AKP)、尿素氮(BUN)、肌酐(Cr)、肿瘤坏死因子-α(TNF-α)、白细胞介素(IL)-6I、L-10I、L-1β、血小板衍生生长因子(PDGF)和胰岛素样生长因子-1(IGF-1)测定,同时行常规病理观察。结果血必净注射液治疗组大鼠动脉血气指标PaO2、PaCO2、pH值明显好于非治疗染毒组,差异有统计学意义(P<0.05或0.01)。治疗组肝肾损害减轻,表现为ALT升高幅度较小,差异有统计学意义(P<0.05),血肌酐变化治疗组明显小于非治疗组,差异有统计学意义(P<0.05)。细胞因子TNF-αI、L-6血必净治疗组与染毒组比较,差异无统计学意义(P>0.05),而IL-10I、L-1β、PDGF和IGF-1高剂量血必净治疗组均明显小于染毒组,差异有统计学意义(P<0.05),PDGF低剂量治疗组也明显小于染毒组,差异有统计学意义(P<0.05)。病理检查示百草枯染毒8 h后肺泡毛细血管的扩张充血,内皮细胞肿胀,出现大量以中性白细胞为主的炎性细胞浸润,肺泡腔内充血,有蛋白水肿液的渗出。血必净治疗组上述改变明显较轻。结论血必净注射液可抑制部分炎性因子的活力。对百草枯中毒脏器损害有治疗保护作用。     

长托宁与阿托品联合应用治疗急性重度有机磷中毒临床分析

目的观察长托宁加阿托品治疗170例急性重度有机磷中毒(severe acute organophosphorus pesticide poisoning,SAOPP)的效果。方法将170例重度AOPP患者随机分为长托宁治疗组、长托宁结合阿托品治疗组及阿托品治疗组,将其疗效与副作用进行对比,统计学分析结果。结果①长托宁加阿托品组较其他两组中毒症状消失时间、乙酰胆碱脂酶(CHE)恢复时间、治愈时间均缩短,治愈率、死亡率均有显著性差异(P<0·05);②单用阿托品组心动过速发生率明显较其他两组高(P<0·01),其他副作用发生无显著性差别。结论长托宁加阿托品是治疗急性重度有机磷中毒最有效的方法。     

百草枯中毒42例临床分析及护理

目的探讨百草枯中毒的发病机制、临床表现和救治方法及护理。方法回顾性分析42例百草枯中毒患者的临床资料。结果42例中死亡33例，死亡率为78．6％。其中发生呼吸衰竭或3个及以上脏器功能衰竭者无一存活；接受血液灌流者死亡率下降（53，8％）。结论百草枯中毒可导致肺、肾、肝等多脏器功能衰竭，死亡率很高，目前尚无特效救治方法。及时有效地清除毒物，早期应用大剂量糖皮质激素和血液灌流有助于提高抢救成功率。