急性有机磷农药中毒致中间综合征37例临床分析

急性有机磷中毒是内科常见急症。中间综合征是急性有机磷中毒经积极救治，急性胆碱能危象消失后，迟发性周围性神经病变出现之前，出现的一组以肌无力为突出表现的临床综合征。部分患者表现为晚发性呼吸肌麻痹。若对其认识不足，不能及时救治，病死率极高。我院近6年来救治急性有机磷中毒218例，其中37例符合中间综合征的诊断标准，现报道如下：     

有机磷中毒中间综合征临床分析

目的:探讨急性有机磷中毒中间综合征(IMS)的临床表现及治疗方法。方法:2005年～2010年患有重度有机磷中毒者128例,其中急性有机磷中毒中间综合征32例,通过观察其临床表现、病程记录、测试血清胆碱酯酶、药物治疗情况和转归记录等进行分析。结果:有机磷中毒中间综合征症状出现在急性中毒后2～5d,IMS的发病率为14.7%(32/218),且96.4%(27/28)发生于中毒后2～5d。32例患者均出现呼吸困难、胸闷、抬头困难、肌腱反射减弱或消失、血清活力低下、睁眼困难等,经ICU抢救,除8例因呼吸肌麻痹、呼吸衰竭死亡,其余均治愈,死亡率为25%(8/32)。结论:有效防治急性有机磷并中间综合征的发生方法是正确合理使用胆碱酯酶复能剂和阿托品,出现呼吸衰竭时应使用呼吸机治疗。     

急性有机磷中毒中间综合征26例临床分析

目的:探讨急性有机磷中毒中间综合征发病机理及诊治。方法:选取急性有机磷中毒中间综合征26例,对26例急性有机磷中毒中间综合征患者临床表现、治疗及转归情况分析。结果:26例患者行气管插管者9例,气管切开17例,治愈23例,治愈患者在中间综合征出现时间3～16 d恢复自主呼吸,逐渐撤除呼吸机,1例死于心跳骤停,1例死于肺部感染,1例死于ARDS。结论:及时机械通气,突击剂量使用氯磷定,合理应用阿托品、纳洛酮,防止肺部感染是治疗的关键,而部分换血疗法等积极综合治疗对有机磷中毒中间综合征有重要意义,能有效提高抢救成功率。     

急性有机磷农药中毒并中间综合征的机械通气治疗及心理护理

目的 总结急性有机磷中毒并发中间综合征的治疗和护理经验。方法 对急性有机磷中毒并发中间综合征34例患施行机械通气,并予以心理护理。结果 34例患中有30例痊愈。结论 急性有机磷中毒并发中间综合征的机械通气治疗配合心理护理是较好的方法。     

26例急性有机磷中毒致中间综合征的救治体会

目的总结有机磷中毒后出现中间综合征的时间、临床表现及治疗方法。方法回顾分析笔者所在医院收治的有机磷中毒致中间综合征患者的临床病例资料。结果有机磷中毒患者出现中间综合征的时间大多在服毒后24～96h,其主要临床表现为呼吸肌麻痹;恢复时间大多在积极治疗后2周左右。结论早期诊断治疗,早期清除毒物,延长阿托品化时间及加量应用胆碱酯酶复能剂,气管插管行机械通气是救治有机磷中毒致中间综合征的关键。     

急性有机磷中毒继发中间综合征的护理

0 引言 急性有机磷中毒继发中间综合征(IMS)是有机磷中毒症状缓解后恢复期发生的最严重的并发症,临床常表现为迅速发展的肌无力(主要是颈肌、上肢肌、呼吸肌及颅神经支配的肌肉瘫痪),若救治不及时,患者可突然死于呼吸衰竭。本文报告 19例中间综合征的护理体会。1 资料 我科1999/2001 共收治中间综合征患者19例,均为口服有机磷农药中毒患者,符合急性有机磷中毒诊断     

急性有机磷中毒致中间综合征42例

急性有机磷中毒（AOPP）患者经积极治疗后可能会出现中间肌无力综合征（IMS）,这是急性有机磷农药中毒除引起急性胆碱危象和迟发性周围神经病外,还可引起一组以肌无力为突出表现的综合征。因其处于急性中毒症状缓解后和迟发性神经病变发生前,约在急性中毒后24～96h突然发生死亡,1987年enanayake和Karalliedde命名为中间综合征。     

长托宁与有机磷中毒发生中间综合征的关系

目的观察长托宁对急性有机磷中毒中间综合征（1MS）发生率的影响。方法回顾性分析2004年-2008年我科收治的132例急性有机磷中毒患者的临床资料,比较阿托品组及长托宁组中间综合征的发病情况。结果阿托品治疗60例中8例发生中间综合征,死亡4例;长托宁治疗72例中1例发生中间综合征,无死亡病例。结论长托宁用于治疗急性有机磷中毒可有效降低中间综合征的发生率。     

急性有机磷农药中毒中间综合征诊治体会

急性有机磷农药中毒中间综合征（IMS）是指急性有机磷农药中毒救治过程中，在急性中毒症状缓解后、迟发性脑病出现前，约在急性中毒后24—96h突然发生死亡。IMS具有无法预料、无法避免及突发性的特点，且病死率较高。我院近9年来收治的有机磷农药中毒患者中共有18例出现IMS，现将诊治体会报告如下。     

有机磷农药中毒中间综合征预防及护理

目的:探讨对有机磷中毒患者如何采取有效措施预防中间综合征的发生。方法:积极彻底洗胃,采取延长胃管插入长度及保留胃管持续胃肠减压,合理有效应用解毒剂及复能剂,同时对病情进行密切的观察及护理。结果:168例急性有机磷中毒患者,165例治愈,并发中间综合征12例抢救成功,3例因抢救无效死亡。结论:有效防治急性有机磷并中间综合征的发生方法是正确合理使用胆碱酯酶复能剂和阿托品,出现呼吸肌麻痹时应使用呼吸机治疗。严密的病情观察可以提高急性有机磷中毒患者的治愈率,减少或避免中间综合征的发生,降低病死率。     

多序列磁共振在急性脑卒中诊断流程中的应用

目的 探讨急性脑卒中发生后最佳的影像诊断流程.方法 发病在1～72h的53例急性脑卒中患者在CT检查后行T1加权成像(T1WI)、T2加权成像(T2WI)、梯度回波T2*加权成像(GRE-T2*WI)、弥散加权成像(DWI)检查,缺血性卒中患者中15例行灌注加权成像(PWI)检查.结果 15例急性脑出血及1例瘤卒中患者的出血灶在GRE-T2*WI上全部清楚显影,3例TIA患者各项均正常.发病在6h内的18例脑梗死患者各项均呈等信号,其中7例患者行PWI检查:3例PWI≥DWI,4例PWI=DWI;发病大于6h的14例患者行GRE-T2*WI均为高信号,DWI均显示有与体征相对应的高信号病灶,其中8例行PWI检查,6例PWI=DWI,2例PWI正常,本组患者中有7例患者GRE-T2*WI呈现有1～18个直径为2～5mm的极低信号;另有1例头痛伴一侧肢体偏瘫的患者在CT上未见异常,T2*WI显示环池有低信号影后证实为蛛网膜下腔出血.结论 对急性脑卒中患者可直接通过MRI多序列检查流程在较短的时间内一站式地鉴别脑出血、脑梗死和TIA,明确微出血情况,确定缺血半暗带,指导溶栓治疗的选择.

Abstract：

Objective To study the best diagnostic imaging procedure after acute stroke.Methods 53 patients with acute stroke were recruited within 72 hours after symptom onset.CT was performed in all patients firstly, then T1 weighted-imaging( T1 WI), T2 weighted-imaging( T2WI ), gradient recalled echo T2 * weighted-imaging( GRE-T2 * WI) and diffusion-weighted imaging(DWI) were examined at 1.5T.Furthermore 15 patients with ischemic stroke received perfusion-weighted imaging(PWI) examination.Results 15 patients with acute cerebral hemorrhage and one patient of hemorrhagic brain tumor appeared clear on GRE-T2 * WI.3 patients with transient ischemic attack(TIA) were normal on T1WI ,T2WI ,GRE-T2* WI and DWI.18 cases with cerebral infarction appeared normal on GRE-T2 * WI within 6 hours after symptom onset, and 7 cases of them underwent PWI examination, the signal intensity of 3 cases were PWI ≥ DWI and of 4 cases were PWI = DWI.14 patients appeared hyperintense on GRE-T2 * WI within 6 ～72 hours after symptom onset.8 patients of them underwent PWI examination,the signal intensity of 6 cases were PWI≥DWI and of 2 cases were PWI = DWI.Of 14 patients,7 patients appeared as 1 ～ 18 dot or patchy hypointense whose diameter was about 2 ～ 5mm on GRE-T2 * WI.Another case of headache with hemiplegia and the side of the limb didnt show abnormalities on the CT, but showed a low signal in ambient cistern on T2 * WI and was proved to be subarachnoid hemorrhage.Conclusion After acute stroke,multi-sequence MRI enables the "one-stop shopping" imaging of cerebral hemorrhage,cerebral infarction and TIA in a shorter time,makes the state of micro-bleeding clear,determines ischemic penumbra,and even guides for thrombolytic treatment.     

A case of wandering spleen: a rare cause of acute abdomen

We present the case of a 17-year-old patient known to have an asymptomatic ectopic spleen, who presented with an acute abdomen. Clinical symptoms and ultrasound led to suspect an acute appendicitis, confirmed later on by pathology. Twenty-four hours after the appendectomy, the patient complained of an abdominal pain of acute onset. Torsion of the pedicle of the ectopic spleen was suspected. Imaging studies supported this diagnosis, and an urgent splenectomy was performed. Did the torsion happen by simple coincidence 24 hours after appendectomy, knowing that the spleen has been asymptomatic for 17 years, or was it precipitated by the surgical intervention? Should we have removed the ectopic spleen during the appendectomy? This is the first report of a case of torsion of a wandering spleen after a laparotomy; a review of the literature is done in order to explain the physiopathology of the disease, and to propose its management.     

Sonographic Diagnosis of Acute Hematogenous Osteomyelitis in the Early Stage

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急性乙型肝炎的前S2抗原

以ELISA检测31例急性乙型肝炎患者的前S_2抗原,24例阳性,检出率77.4％。前S_2抗原最早出现于第一病日,最迟检出的一例在第23病日。22例(91.6％)该抗原于发病后4周内消失,2例在病后24周仍持续阳性。前S_2抗原与抗-HBcIgM阳性,高滴度HBsAg,HBVDNA和HBeAg阳性及ALT异常有关,因而它是乙型肝炎病毒复制的另一标志。前S_2抗原的持续可能表示肝炎有慢性化趋势。     

超黄金治疗期的缺血性中风大鼠模型、治疗模式及疗效表述

目的 研究长时缺血性中风大鼠模型及治疗有效性和出血不良反应.方法连续给药7 d,使用自身对照法对大鼠进行单独的神经评分.结果体内实验中立即给予1 μmol/kg自由基多肽缀合物（JXY,Gly-Arg-Pro-Ala-Lys-Arg-Gly-Asp-Val）治疗急性缺血性脑卒中大鼠,或发病4、6和24 h后给药均可治愈.这种优势在以JXY 1 μmol/kg为初始剂量并持续给药时被进一步增强.相反,3 mg/kg t-PA没有这样的治疗效果.结论 急性缺血性脑卒中发病超过3 h后的溶栓治疗中提高t-PA的疗效和限制其神经毒性具有重要的临床意义.急性缺血性脑卒中发病后4、6、24 h的大鼠模型具有广泛的用途.1 μmol/kg JXY在急性缺血性脑卒中大鼠模型中立即治疗或发病4、6、24 h后治疗均有效.     

急性乙型肝炎表面系统的动态与预后的关系

在随访的185例急性病毒性肝炎病人中,乙型肝炎的HBsAg阳性率为76.1％,高于慢性乙肝(54.4％)和甲、乙型肝炎合并感染者(53.8％)。发病初期HBsAg滴度低者在发病后1个月内降低或消失,持续时间不超过3个月,恢复期抗-HBs阳转;高者持续阳性9个月以上,不发生抗体阳转。据此可作出预后的早期判断。抗-HBcIgM阳性、NBsAg阴性者抗-HBs阳转率(42.9％)高于HBsAg阳性者(11.3％)。绝大多数病人(91.7％)的抗体阳转发生在病后2个月内。     

急性乙型肝炎e系统动态及与其它HBV标志关系的研究

以SPDP-ELISA检测38例HBsAg阳性急性乙型肝炎病人的e系统,检出率为97.7％。13例HBsAg阴性、抗-HBc IgM阳性急性乙肝e系统检出率为23.1％。慢性乙肝e系统检出率为95.5％。发病后半年内抗-HBe阳转4例,有3种类型。并发现HBeAg与抗-HBc IgM阳性,高滴度HBsAg、HBV-DNA阳性、ALT异常有关,均属HBV复制标志。     

急性炎症期腹腔镜胆囊切除术43例分析

目的探讨急性炎症期腹腔镜胆囊切除术的可行性和手术时机。方法对43例急性炎症期行腹腔镜胆囊切除术患者的临床资料进行回顾性分析。结果43例均成功完成腹腔镜胆囊切除术。发病72h内手术者28例,术后无并发症,其中手术容易12例;发病72h后手术者15例,其中手术容易3例,术后发生胆漏1例,经保守治疗痊愈。结论急性炎症期腹腔镜胆囊切除术是可行的,手术时机最好在发病72h。     

The development of hepatitis C antibody shortly after acute icteric non-A non-B hepatitis.

OBJECTIVE: To determine the relationship between the development of hepatitis C antibody (anti-HCV) and the clinical symptoms in acute hepatitis C. DESIGN: Retrospective analysis of sera from patients with acute non-A non-B hepatitis. SETTING AND PATIENTS: Patients admitted to Fairfield Hospital with the diagnosis of acute non-A non-B hepatitis between 1979 and 1989. Inclusion criteria included a typical clinical illness, accompanied by an alanine aminotransferase level of more than 2.5 times the upper limit of normal (normal, less than or equal to 40 U/L) and negative serological test results for acute hepatitis A and B. MAIN OUTCOME MEASURE: Time to develop anti-HCV after the onset of symptoms in patients with acute hepatitis C. RESULTS: Seroconversion was demonstrated in 26 of the 128 patients who fulfilled the inclusion criteria. In these patients, antibody was detected between one week and 32 weeks after the onset of dark urine; more than half the patients (54%) had seroconverted by four weeks and a third (34%) developed antibodies within two weeks. Of 20 patients who had sera collected within four weeks of the onset of dark urine, 14 (70%) had developed antibody. CONCLUSION: These results suggest that in patients with community-acquired hepatitis C, seroconversion occurs significantly earlier than is observed in patients who have been infected by blood transfusion. Sera taken shortly after the onset of symptomatic hepatitis C may be useful in the diagnosis of this condition.     

多发性硬化35例临床分析

目的探讨多发性硬化（MS）的临床特点。方法回顾性分析35例多发性硬化患者的一般临床表现及辅助检查。结果MS多见于青壮年,起病多为急性或亚急性,多数无明显诱因,首发症状以肢体无力、感觉障碍及视觉障碍为主要表现,全部症状和体征以肢体无力及感觉障碍为主,颅脑MRI及诱发电位具有很高的诊断价值。结论根据临床特点,脑脊液检查及影像学检查能大大提高临床确诊率,其中诱发电位、磁共振成像意义较大。