46例急性有机磷农药中毒死亡原因分析

目的 :探讨急性有机磷中毒 (AOPP)死亡。方法 :回顾分析 1998年至 2 0 0 0年 8月死亡病例 4 6例 ,占同期中AOPP5 0 8例的 9.0 6 %。结果 :洗胃不彻底 15例 (32 .6 % ) ,阿托品用量不足 12例(2 6 .1% ) ;中间综合征 (IMS) 7例 (15 .2 % )阿托品中毒 5例 (10 .9% ) ;混合性中毒 3例 (6 .5 % ) ,其余存在严重并发症。结论 :表明洗胃不彻底 ,阿托品用量不足及中毒、IMS、混合性中毒是AOPP死亡的主要原因。对AOPP并发的紧急凶险症状未及时控制也是其死亡原因之一。     

酸血症对有机磷农药中毒家兔模型阿托品化量影响的实验研究

目的：探讨酸中毒对有机磷农药中毒病人阿托品化量的影响。方法：采用家兔80只,随机分为两组,一组制造酸血症模型,另一组对照,两组均注射公斤体重相同剂量的有机磷农药,制造有机磷农药中毒模型,而后用阿托品解救,并达到阿托品化状态,比较两组阿托品的用量。结果：酸血症组阿托品用量明显高于对照组。结论：有机磷中毒病人合并酸中毒时,阿托品化量,高于正常。及时纠正酸中毒, 有利于有机磷中毒患者的治疗。     

雪 卡 毒 素 中 毒 的 临 床 特 征

目的 探讨雪卡毒素中毒时的临床特征。方法 分析25（男18,女7）例中毒病人的临床资料。结果 病人在进食有毒海鱼后2至10小时,出现神经、消化、心血管系统症状。普遍均有消化系统症状,神经系统症状持续1至2周,并温度感觉倒错最具有特征性。结论 雪卡毒素中毒病人,可根据其临床上特殊的神经系统特点得到确认。     

Macroscopic hematuria in wasp sting patients: a retrospective study

BackgroundMacroscopic hematuria after wasp sting has been reported in Asia to occur before acute kidney injury (AKI), and is often used by clinicians as a sign indicating the need for intensive care and blood purification therapy. However, there is no study on the clinical characteristics and prognosis of this symptom.MethodsThe clinical data of 363 patients with wasp sting admitted to Suining Central Hospital from January 2016 to December 2018 were retrospectively analyzed. At admission, the poisoning severity score (PSS) was used as the criterion for severity classification. According to the presence of macroscopic hematuria, the patients were divided into macroscopic hematuria and non-macroscopic hematuria group.ResultsOf the 363 wasp sting patients, 219 were male and 144 were female, with a mean age of 55.9 ± 16.3 years. Fifty-one (14%) had macroscopic hematuria, 39 (10.7%) had AKI, 105 (28.9%) had rhabdomyolysis, 61 (16.8%) had hemolysis, 45 (12.4%) went on to received hemodialysis, and 14 (3.9%) died. The incidence of AKI in macroscopic hematuria group was 70.6%, and oliguric renal failure accounted for 72.2%. Patients with macroscopic hematuria had significantly higher PSS (2.2 ± 0.5 vs. 1.1 ± 0.3, p < .001).ConclusionMacroscopic hematuria can be regarded as a surrogate marker of deteriorating clinical outcome following wasp stings. In wasp sting patients with symptoms of macroscopic hematuria or serum LDH higher than 463.5 u/L upon admission, the risk of AKI increases significantly, therefore hemodialysis should be considered. The PSS is helpful in early assessment of the severity of wasp sting patients.     

Updates in our understanding of local anaesthetic systemic toxicity: a narrative review

Despite advances in clinical practice, local anaesthetic systemic toxicity continues to occur with the therapeutic use of local anaesthesia. Patterns of presentation have evolved over recent years due in part to the increasing use of ultrasound which has been demonstrated to reduce risk. Onset of toxicity is increasingly delayed, a greater proportion of clinical reports are secondary to fascial plane blocks, and cases are increasing where non-anaesthetist providers are involved. The evolving clinical context presents a challenge for diagnosis and requires education of all physicians, nurses and allied health professionals about these changing patterns and risks. This review discusses: mechanisms; prevention; diagnosis; and treatment of local anaesthetic systemic toxicity. The local anaesthetic and dose used, site of injection and block conduct and technique are all important determinants of local anaesthetic systemic toxicity, as are various patient factors. Risk mitigation is discussed including the care of at-risk groups, such as: those at the extremes of age; patients with cardiac, hepatic and specific metabolic diseases; and those who are pregnant. Advances in the changing clinical landscape with novel applications and settings for the use of local anaesthesia are also described. Finally, we signpost future directions to potentially improve the management of local anaesthetic systemic toxicity. The utility of local anaesthetics remains unquestionable in clinical practice, and thus maximising the safe and appropriate use of these drugs should translate to improvements in patient care.     

国产氟马西尼的临床应用

探讨苯二氮 艹卓 受体拮抗剂 氟马西尼治疗昏迷的临床价值。结果表明 :氟马西尼治疗后 15 ,30 ,6 0和 180minMGCS得分较治疗前依次增加 5 3,8 0 ,9 4和 7 3分 ,较常规药物组分别增加 5 2 ,7 7,8 7和 6 9分 (P <0 .0 1)。治疗后OAA/S得分也较治疗前增加 1 9分 (P <0 .0 1)。治疗过程中除少数患者出现轻度激越现象和窦性心动过速外 ,未发现其它副作用。提示氟马西尼能有效地拮抗因急性苯二氮 艹卓 类药物中毒而引起的意识障碍 ,具有较好的抗昏迷作用     

大鼠急性氧中毒后全脑细胞能量代谢的活体^31P磁共振谱 …

目的：探讨大鼠急性氧中毒后脑的能量代谢产物与脑细胞内ＰＨ变化的规律。方法：采用磁共振方法,用４．７Ｔ动物磁共振谱仪,检测氧中毒后不同时程各种磷酸化合物与无机磷酸根（Ｐｉ）、磷酸肌酸（ＰＣｒ）与γ－ＡＴＰ以及β－ＡＴＰ与Ｐｉ之间的比值,并根据Ｐｉ的化学位移推算脑细胞内ＰＨ值。结果：氧中毒组物舱１和３小时后ＰＣｒ／Ｐｉ,ＰＣｒ／γ－ＡＴＰ以及β－ＡＴＰ／Ｐｉ值均显著降低;５ｈ后恢复正常;２４和４８小时     

慢性砷中毒自觉症状和皮肤改变影响因素的Logistic分析

目的探讨慢性砷中毒患者自觉症状、皮肤色素异常丑过度角化的影响因素。方法选择山西大同地区山阴县黑疙瘩乡大营村进行调查问卷及体检,结果进行单因素及多因素Logistic逐步回归分析。结果单因素分析提示,年龄、迁入时间、饮含砷井水时间、吸烟、饮茶等与自觉症状、色素异常及皮肤角化显著相关,水果是保护因素。多因素Logistic逐步回归分析结果表明,年龄、迁入时间是自觉症状的主要危险因素;年龄是色素异常的主要危险因素,水果摄入是保护因素;年龄、迁入时间、饮含砷井水时间是皮肤过度角化的主要危险因素,水果摄入是保护因素。结论自觉症状及皮肤改变主要与砷的撮入及蓄积量有关。砷中毒病区地理环境背景也是影响皮肤改变的因素之一。水果等抗氧化物质的摄入可能起保护作用。     

巯基化合物对毒鼠强急性中毒小鼠的保护作用

目的：探讨巯基化合物对毒鼠强急性中毒小鼠的解毒作用。方法：通过小鼠急性毒性实验,观察多种巯基化合物的解毒作用。结果：巯基化合物能不同程度地延长毒鼠强中毒小鼠的惊厥潜伏期及死亡时间,二巯丙磺纳及二巯丁二纳还可明显降低中毒小鼠死亡率。结论：二巯丙磺纳和二巯丁二钠对毒鼠强中毒小鼠有明显的保护作用,尤以二巯丙磺钠为最佳（Ｐ〈０．００１）。     

脑电图结合CT预测一氧化碳中毒迟发性脑病

探讨预测一氧化碳中毒迟发性脑病的检查方法,以及高压氧治疗时间与脑病的关系。方法用脑电地形图和头颅ＣＴ分析２９３例一氧化碳中毒不同程度、不同高压氧治疗时间与一氧化碳中毒迟发性脑病发生的关系。结果中重度中毒脑电地形图与轻度中毒异常率比较差异显。