中药肠道灌洗联合血液净化治疗急性农药中毒的临床疗效探讨

目的 探讨中药肠道灌洗联合血液净化治疗急性农药中毒的临床疗效。方法 选取2014年4月～2019年10月本院收治的50例急性农药中毒患者为研究对象,并根据不同的治疗方案将患者分为对照组与观察组,各25例,对照组采用常规治疗联合血液净化治疗,而观察组在对照组的基础上采用中药肠道灌洗治疗,比较两组患者的临床疗效及血压、血气指标情况。结果 治疗后,观察组的临床总有效率为96.00%,对照组为76.00%,两组比较,观察组明显高于对照组;同时观察组的收缩压(SBP)、舒张压(DBP)与酸碱度(pH)高于对照组,动脉血氧分压(PaO2)与动脉血二氧化碳分压(PaCO2)低于对照组,组间比较差异有统计学意义(P0.05)。结论 对急性农药中毒患者实施中药肠道灌洗联合血液净化治疗,能有效改善患者的血压、血气指标,具有显著的临床疗效。     

一起由两种罕见血清型副溶血性弧菌引起食物中毒事件分析

目的 分析一起由两种罕见血清型混合感染引起的副溶血性弧菌食物中毒病原学的检测结果,为食物中毒病原学检查途径提供依据。方法 对一起在龙门县人民医院就诊食物中毒事件的9例患者采集其肛拭子样本,参照《食品微生物学检验副溶血性弧菌检验》( GB 4789.7—2013) 等标准进行病原学分析鉴定。结果 本次事件出现临床症状者9例,其中≤20岁2例,20~<40岁1例,40~<60岁4例,≥60岁2例;9份肛拭子样本检出8株副溶血性弧菌,血清分型O2:K28构成比占25.00%(2/8);O8:K21构成比占75.00%(6/8);经PFGE分子分型,2株O2∶K28血清型(VP18171、VP18175)相似度为66.7%;3株O8∶K21血清型(VP18172、VP18173、VP18176)相似度为100.0%,与另外3株O8∶K21血清型(VP18177、VP18174、VP18170)相似度为88.4%~95.2%;药敏试验结果显示,除有1株菌株对氨苄西林、头孢唑林二重耐药、1株菌株对氨苄西林耐药、3株菌株对头孢唑林耐药外,其它菌株对所有测试药物均敏感,无多重耐药现象。结论 此次食物中毒是由O2:K28和O8:K21这两种罕见血清型的副溶血性弧菌混合感染引起的。     

Capillary leak syndrome: A rare cause of acute respiratory distress syndrome

Capillary leak syndrome (CLS) is a rare clinical syndrome associated with significant morbidity and mortality. Intensive care and supportive therapy constitute the mainstay of the treatment, along with judicious use of crystalloids and colloids such as dextran and starch during the leak phase. The advantages of proning, steroids, and intravenous immunoglobins are worth contemplating in patients with such a presentation. Extracorporeal membrane oxygenation appears to be an excellent strategy to surmount the impediments of the leak and post leak phase of CLS, especially in patients with severe or refractory hypoxemia.     

PA-aO2、PaCO2和Lac水平与急性百草枯中毒患者的预后的相关性

目的探究肺泡-动脉氧分压差(PA-aO2)、动脉血二氧化碳分压(PaCO2)和血乳酸(Lac)水平与急性百草枯中毒(APP)患者的预后的相关性。方法选取2018年8月至2020年8月就诊于本院的126例APP患者,根据3个月随访情况,分为存活组57例和死亡组69例,另选取同期于本院进行健康体检的健康人群45例作为对照组,检测3组PA-aO2、PaCO2和Lac水平。结果与对照组比较,APP患者PA-aO2和Lac水平显著升高,PaCO2水平显著降低,且死亡组变化幅度显著大于存活组,差异有统计学意义(P<0.05);PA-aO2和Lac与存活组呈负相关,与死亡组呈正相关,PaCO2与存活组呈正相关,与死亡组呈负相关(P<0.05);PA-aO2、PaCO2和Lac联合检测对APP患者预后的预测价值显著高于单一指标,差异有统计学意义(P<0.05)。结论PA-aO2、PaCO2和Lac水平与APP患者预后密切相关,值得临床参考。     

Acute liver injury,acute liver failure and acute on chronic liver failure: A clinical spectrum of poisoning due to Gyromitra esculenta

Gyromitra esculenta, also known as “false morel” is one of the most poisonous mushrooms. This species is found all over the world, growing in coniferous forest in early spring time. Common manifestation of poisoning includes gastrointestinal symptoms which include varied degrees of liver impairment.We describe three cases: acute liver injury, acute liver failure and acute-on-chronic liver failure due to G. esculenta poisoning. At admission patients presented with encephalopathy and features of liver failure. Two of them recovered completely following supportive management while the remaining patient who also had preexisting liver disease developed multiorgan failure and subsequently died.Although a rare occurrence, G. esculenta poisoning should be considered in the differential diagnosis of acute liver failure.     

大黄鼻饲、保留灌肠对重症有机磷中毒患者血清瓜氨酸水平及胃肠功能的影响

目的探讨大黄鼻饲、保留灌肠对重症有机磷中毒患者血清瓜氨酸水平及胃肠功能的影响。方法68例患者按入院先后顺序编码、按随机数字表法随机分为对照组和观察组两组各34例。对照组给予解毒剂阿托品、复能剂氯解磷定、血液灌流等综合治疗。观察组在对照组基础上给予生大黄鼻饲及保留灌肠。两组均连续治疗3 d。比较两组胃肠道功能恢复正常的时间和胆碱酯酶、血清瓜氨酸的变化情况,以及两组患者住重症监护室的时间。结果68例患者均全部治愈出院,无死亡病例。观察组胃肠障碍恢复至正常所需时间和住ICU时间均短于对照组(P<0.05)。在给予大黄鼻饲、保留灌肠治疗前,两组全血胆碱酯酶活力及血清瓜氨酸含量比较,差异无统计学意义(均P>0.05)。给予大黄鼻饲、保留灌肠治疗第3日,两组各指标均明显升高,观察组全血胆碱酯酶活力及血清瓜氨酸含量均高于对照组(均P<0.05)。结论生大黄鼻饲及灌肠可改善重症有机磷中毒患者胃肠功能,提高患者血清瓜氨酸水平,缩短病程,提高临床疗效。     

急诊急救护理对有机磷农药中毒患者的效果观察

目的探讨急诊急救护理对有机磷农药中毒患者的效果。方法将2016年3月-2019年3月我院收治的74例有机磷农药中毒患者按随机数字表法分为观察组(n=37)和对照组(n=37)。对照组患者给予常规的急救护理,观察组在对照组的基础上给予高效一体化急救护理。比较两组患者的洗胃时间、洗胃液体容量、胃内容物溢出率以及抢救成功率。结果观察组的洗胃时间、洗胃液体容量、胃内容物溢出率均要明显低于对照组;观察组患者抢救成功率明显高于对照组(P<0.05)。结论对有机磷农药中毒患者应用高效的急诊急救护理,能够明显减少患者的洗胃时间、洗胃液体容量、胃内容物溢出率,提高抢救成功率,值得临床应用。     

Characterization of a Parkinson’s disease rat model using an upgraded paraquat exposure paradigm

Animal models of human diseases are crucial experimental tools to investigate the mechanisms involved in disease pathogenesis and to develop new therapies. In spite of the numerous animal models currently available that reproduce several neuropathological features of Parkinson disease (PD), it is challenging to have one that consistently recapitulates human PD conditions in both motor behaviors and biochemical pathological outcomes. Given that, we have implemented a new paradigm to expose rats to a chronic low dose of paraquat (PQ), using osmotic minipumps and characterized the developed pathologic features over time. The PQ exposure paradigm used lead to a rodent model of PD depicting progressive nigrostriatal dopaminergic neurodegeneration, characterized by a 41% significant loss of dopaminergic neuron in the substantia nigra pars compacta (SNpc), a significant decrease of 18% and 40% of dopamine levels in striatum at week 5 and 8, respectively, and a significant 1.5‐fold decrease in motor performance. We observed a significant increase of microglia activation state, sustained levels of α‐synucleinopathy and increased oxidative stress markers in the SNpc. In summary, this is an explorative study that allowed to characterize an improved PQ‐based rat model that recapitulates cardinal features of PD and may represent an attractive tool to investigate several mechanisms underlying the various aspects of PD pathogenesis as well as for the validation of the efficacy of new therapeutic approaches that targets different mechanisms involved in PD neurodegeneration.     

急性百草枯中毒严重程度的早期评估及预后

急性百草枯中毒(APP)死亡率高,可引起多器官功能障碍甚至衰竭,临床治疗方案常采用多项措施联合的集束化治疗。故在患者就诊早期即对APP严重程度进行评估,能够为临床治疗方法的选择提供指导,对启动不同级别的治疗措施和预后改善都具有重要的临床价值。本文就早期评估APP严重程度及预后的研究进展做一述评。