急性酒精中毒的救治及护理

酒精对人体中枢神经系统有抑制作用,一次饮酒过量即会导致神经精神症状为主的疾病,称酒精中毒。酒精中毒不仅给患者健康形成损害,重度酒精中毒还可危及生命。而近年来,随着生活水平的提高,人们生活方式的改变,与饮酒中毒相关的心理和社会问题也逐渐增多。作者对本院自2006年1月     

急性酒精中毒的急救护理配合

目的:探讨急性酒精中毒急诊临床救治的有效护理配合策略.方法:回顾性分析我科2009年8月-2010年12月收治的55例急性酒精中毒患者的临床护理资料.结果:55例患者经治疗后神志转清时间为2.8-3.5小时,平均3.0±0.4小时,平均留院观察时间为1.0±0.2天.本组无死亡及吸入性肺炎病例.结论:快速清除胃肠道内尚未吸收的乙醇,建立有效的静脉通路、良好的气道管理,促醒药物应用后的强化临床观察等是急性酒精中毒患者急诊临床救治的合理、有效的护理配合策略.     

纳洛酮舌下含片治疗急性酒精中毒

对54例急性单纯酒精中毒患者随机分组，比较盐酸纳洛酮（NX）舌下含片与常规治疗的疗效。结果表明，NX舌下含片可使酒精中毒者症状迅速缓解，明显缩短中毒后各项恢复时间，其疗效时间与文献报告的NX静脉给药相近。对轻度中毒者比较不同首剂量发现，首剂量0．8mg较0．4mg疗效更为明显。本文结果显示，NX舌下含片治疗急性酒精中毒疗效确实，而较静脉给药更为简便、安全、经济。     

纳洛酮治疗急性酒精中毒的疗效观察

目的：观察纳洛酮在治疗急性酒精中毒的疗效。方法：将77例急性酒精中毒者分为两组：纳洛酮组39例，除给予常规治疗外，静脉推注纳洛酮0．8mg，疗效不明显者，0．5h，1．0h后重复注射，胰岛素治疗组38例；在给予常规治疗的基础上，静脉点滴8U-12U胰岛素。结果：纳洛酮治疗组的催醒时间明显少于胰岛素组（P〈0．01），且醒后头昏、头痛、电解质紊乱的发生率明显减少。两组比较有显著性，具有统计学意义。结论：使用纳洛酮治疗急性酒精中毒是安全有效的。     

纳洛酮治疗急性酒精中毒的疗效观察

目的：观察纳洛酮在治疗急性酒精中毒的疗效。方法：将77例急性酒精中毒者分为两组：纳洛酮组39例，除给予常规治疗外，静脉推注纳洛酮0．8mg，疗效不明显者，0．5h，1．0h后重复注射，胰岛素治疗组38例；在给予常规治疗的基础上，静脉点滴8U～12U胰岛素。结果：纳洛酮治疗组的催醒时间明显少于胰岛素组（P〈0．01），且醒后头昏、头痛、电解质紊乱的发生率明显减少。两组比较有显著性，具有统计学意义。结论：使用纳洛酮治疗急性酒精中毒是安全有效的。     

纳络酮在急性酒精中毒中的应用

我院自2000～2006年收治急性酒精中毒患者123例，均采用以纳络酮为主的药物的治疗，效果满意，现报告如下。     

纳洛酮治疗急性酒精中毒疗效观察

采用纳洛酮治疗急性酒精中毒１０２例，经观察，在催醒速度、治疗方法、治疗效果、救治成功率等方面明显优于常规治疗组（Ｐ＜０．００１）。     

急性酒精中毒的急救与护理

23例急性酒精中毒病人经积极的催吐、洗胃,保持呼吸道通畅,建立静脉通道,进行血液透析等治疗,均治疗痊愈出院。无并发症发生。认为保持呼吸道通畅是急性酒精中毒急救的基础,减少乙醇吸收、促进排泄、恢复意识是急救的关键。     

Rhabdomyolysis following acute alcohol intoxication.

The case of a fit young man who developed rhabdomyolysis after a short period of immobilization following acute alcohol intoxication is described. Rhabdomyolysis should be considered in an intoxicated patient presenting with muscle tenderness, particularly after immobilization.     

Efficacy of metadoxine in the management of acute alcohol intoxication

This randomized, open-label study evaluated the efficacy of 300 mg metadoxine (given intravenously) added to standard treatment compared with standard treatment alone in managing the physical and psychological signs of acute alcohol intoxication. Fifty-two acutely intoxicated patients were randomly assigned to one of two groups and followed during a 2-h period. Changes in clinical symptoms, degree of intoxication, and blood alcohol level were monitored. More patients receiving metadoxine in addition to standard therapy significantly improved by at least one degree of intoxication (one clinical category) compared with those receiving standard treatment alone (76.9% versus 42.3%, respectively). Metadoxine-treated patients also exhibited a significantly greater decrease in blood alcohol concentration compared with those receiving standard treatment alone (-105.4 +/- 61.5 mg/dl versus -60.1 +/- 38.6 mg/dl, respectively). Metadoxine improved the clinical signs of acute alcohol intoxication and accelerated alcohol clearance from the blood, thus supporting existing data. In contrast to previous data, these effects were concurrent but independent. No adverse effects were observed with metadoxine therapy.     

Children presenting to hospital with acute alcohol intoxication

Aims

To investigate the problem of children presenting to hospital with alcohol intoxication.

Methods

An observational study was conducted over 18 months profiling children who presented to hospital with acute alcohol intoxication, proved by laboratory tests on blood alcohol levels (BALs). The study was part of a multicentre‐funded injury prevention project based on the widely accepted Canadian Hospital Injury Reporting and Prevention Programme.

Results

62 children (31 boys), mean age 14.5 years, presented with alcohol intoxication proved by BALs. The mean BAL was 203 mg/dl (standard deviation (SD) 80.7). As a point of reference, 56 (90%) children had BAL above the UK legal driving limit of 80 mg/dl. The most common type of alcohol consumed was spirits, in the form of whisky, gin, vodka and tequila. No significant association was seen between age and BAL. Children with high alcohol levels were much more likely to have lower Glasgow Coma Scores (p<0.001), but in contrast with conventional teaching, there was no association between blood glucose levels and BALs. The median Glasgow Coma Score on admission to the emergency department was 12. 15 (24%) children had a score ⩽8/15. Injuries were present in 21 (34%) children, most of which were minor injuries. Minor head injury was most common, accounting for 42% of the injuries. The most common cause of injury was a fall.

Discussion

The results of this study confirm the heavy use of alcohol by some young children. This highlights a definite problem, which needs to be dealt with by a variety of measures, giving particular consideration to the ease of access to alcohol by children.The relationship between alcohol misuse and attendance in the emergency department is well established for adults.¹ In adults there is also a clear correlation between alcohol misuse and severity of injury.^2,3,4 However, little is known about alcohol misuse and mechanisms of injury in children.⁵ Children in the UK are reported to have the highest rates of drunkenness, binge drinking and alcohol consumption in Europe.⁶ Although deaths in children from the toxic effects of alcohol are rare, co‐morbidity is positively correlated with risk‐taking behaviours such as substance misuse, criminal activity, depression, suicide, conduct disorder, early pregnancy, poor educational attainment and unemployment.⁷ The purpose of this study is to profile children presenting to the emergency department with acute alcohol intoxication proved by blood alcohol levels (BALs). This may facilitate the implementation of effective intervention and preventive strategies to reduce alcohol‐related injury and comorbidity.     

Disturbances of electrolytes and blood chemistry in acute alcohol intoxication

Prevalence of electrolyte disturbances and biochemical changes were determined in patients admitted to the emergency room of the Department of Internal Medicine in Innsbruck, Austria during a six-month period. The value of biochemical parameters for the detection of chronic alcohol abuse was also investigated. The most frequent electrolyte disturbances found were hypernatremia (41%), hyperchloremia (21%), hypermagnesemia (17%) and hypocalcemia (15%), whereas hypokalemia and hypophosphatemia were observed quite rarely (5% and 3.4%, respectively). The most frequent biochemical changes observed were consistent with signs of cellular toxicity i.e. increased liver enzymes (elevated gamma-glutamyltransferase (GGT), aspartate aminotransferase, alanine aminotransferase and lactic dehydrogenase) as well as signs of pancreatitis (elevated serum lipase and amylase) and muscle damage (elevated creatine kinase). The most frequent changes in blood counts were leucocytosis (23%), thrombocytopenia (14%), and anemia (12%). C-reactive protein showed only minimal elevation. Male sex and level of blood alcohol were detected as major risk factors for the diagnosis of chronic alcohol abuse in the patient sample investigated. When testing the value of routinely measured parameters for predicting the presence of chronic alcohol abuse, GGT and mean corpuscular volume of red blood cells (MCV) appeared to be of equal value. A combination of elevated blood alcohol with an increase in either of these markers may be interpreted as high risk for chronic alcohol abuse in this particular group of patients.     

急性酒精中毒的抢救与护理

目的：探讨急性酒精中毒的抢救与护理的有效方法。方法：对42例急性酒精中毒患者的抢救与护理过程进行回顾总结,即快速建立静脉通道、吸氧、生命体征监测、纳洛酮的应用、保持呼吸道通畅、病情观察、并发症的预防等。结果：42例急性酒精中毒患者1-3 d后全部痊愈出院。结论：及时、正确地采取有效措施是抢救成功的关键。     

Altered hemodynamic counter-regulation to hemorrhage by acute moderate alcohol intoxication

The incidence of traumatic injury, frequently associated with hemorrhagic shock, is higher in the alcohol-intoxicated individual. The outcome, as it pertains to both morbidity and mortality of this population, is partly dependent on duration of alcohol exposure and levels of blood alcohol at time of injury. In previous studies, we demonstrated that prolonged alcohol intoxication (15-h duration) produces marked hemodynamic instability and exacerbated early lung proinflammatory cytokine expression after hemorrhagic shock. The present study examines whether a shorter and more modest period of alcohol intoxication is sufficient to alter hemodynamic and proinflammatory responses to hemorrhagic shock. Chronically instrumented, conscious male Sprague-Dawley rats (250-300 g) received a single intragastric bolus of alcohol (1.75 g/kg) 30 min before the administration of fixed-volume (50%) hemorrhagic shock, followed by fluid resuscitation with Ringer lactate. Time-matched controls were administered on isocaloric dextrose bolus (3 g/kg). Alcohol (blood alcohol concentration, 152 +/- 10 mg/dL) produced a 14% decrease in basal mean arterial blood pressure and a more profound hypotensive response to equal blood loss. The 2-fold rise in circulating norepinephrine levels was similar in alcohol- and dextrose-treated hemorrhaged animals despite greater hypotension in alcohol-treated animals. Significant upregulation in lung and spleen interleukin (IL) 1, IL-6, IL-10, and tumor necrosis factor alpha expression was observed immediately after hemorrhage and fluid resuscitation, as previously reported. Only the hemorrhage-induced rise in lung IL-6 and tumor necrosis factor alpha was prevented by alcohol administration. In contrast, spleen cytokine responses to hemorrhage were not altered by alcohol administration. These results indicate that moderate acute alcohol intoxication results in significant modulation of hemodynamic and neuroendocrine responses to hemorrhagic shock.     

Peculiarities of pharmacological correction of acute toxic hepatopathies in patients with severe forms of acute alcohol intoxication

Results of examination and treatment of 130 patients with severe alcoholic intoxication and toxic hepatopathy in conjunction with metabolic disorders are presented Inclusion of remaxol in therapy of alcoholic intoxication improved its clinical course (reduction in the frequency of secondary pulmonary complications from 18.5 to 3. 1%, the frequency and duration of alcoholic delirium from 33.9 to 10.8%, the duration of stay in an intensive therapy ward from 7.3+/-0.6 to 5.6+/-0.3 days and the overall duration of therapy from11.8+/-1.05 to 5.6+/-0.3 days). Moreover, remaxol and ademetionine improved biochemical characteristics of the patients deteriorated as a result of hepatic toxicosis. This effect of remaxol was more pronounced than that of ademetionine.