急性口服百草枯中毒死亡分析

目的 探讨急性口服白草枯中毒死亡原因。方法 回顾分析7例临床资料。结果 7例患者均有多脏器功能衰竭,皆死亡。4例死于急性呼吸窘迫综合征（acute respiratory distress syndrome,ARDS）,3例死于循环衰竭。结论 急性口服白草枯中毒死亡率很高．死于ARDS和循环衰竭为主的多脏器功能衰竭。对此除草剂的认识不足,早期治疗不当,缺乏有效治疗与死亡有关。     

CRRT抢救危急重症病人的体会（附13例分析）

目的：探索应用连续性肾脏替代治疗（CRRT）抢救危急重症病人的效果。方法：对伴有急性肾衰（acute renal failure,ARF)及多脏器功能衰竭（multi-organ failure,MOF)13例病人，应用CRRT进行治疗，并观察各项指标变化，结果：13例伴有急性肾衰及多脏器功能衰竭患者抢救成功6例，死亡7例，取得了较好的疗效。结果：CRRT是抢救急性肾衰及多脏器功能衰竭的有效方法，早期应用能显著提高抢救成功率。     

慢性肺心病急性加重期多脏器功能衰竭死亡原因分析

目的：探讨慢性肺心病急性加重期多脏器功能衰竭的诱因、防治方法及预后。方法：回顾性分析我院收治的376例慢性肺心病急性加重期病人的临床资料。结果：死亡36例（9．5％）,其中多脏器功能衰竭死亡32例占88．89％,2脏器10例di31．25％,3脏器16例占50％,4脏器4例占12．5％,6脏器2例占5．25％。各脏器发生率：呼吸衰竭32例,肺性脑病18例,肾功能衰竭18例,肝功损害10例,上消化道出血6例,DIC4例,分别为100％、55．25％、37．5％、18．75％和12．50％。所有病人均因感染加重和缺氧而入院。结论：感染和低氧血症是脏器功能衰竭的主要原因,治疗的关键是尽快抗感染纠正低氧血症,保护脏器功能。     

氟乙酰胺中毒致多脏器功能衰竭的护理体会（附1例报告）

氟乙酰胺中毒致多脏器功能衰竭的护理体会（附１例报告）福建医学院附属第一医院郑靖生，冯周清我院１９９４年收治１例氟乙酰胺中毒致多脏器衰竭的患儿，经医护人员精心治疗与护理、治愈出院。现将护理体会报告如下。一、病例介绍患儿男，５岁。以误服浸有氟乙酰胺鼠药饼...     

林芝地区急性毒蕈中毒78例临床分析

目的　探讨林芝地区毒蕈中毒的临床特征及治疗方法。　方法　对我院 2 0 0 3年 7～ 8月收治的78例毒蕈中毒患者进行临床分析。　结果　 77例患者以胃肠炎型为主 ,1例中毒患者因急性溶血、多脏器功能衰竭及出血倾向死亡。　结论　重视毒蕈中毒的临床特点 ,争取早期联合治疗 ,防止肝、肾等多脏器功能的损害     

应用血液透析联合血液灌流治疗急性中毒患者的护理体会

目的探讨血液灌流(HP)联合血液透析(HD)治疗急性中毒的临床效果和护理。方法对84例中毒患者采用血液灌流联合血液透析的临床资料进行分析。结果本组病例有81例治愈,3例因时间过长引起多脏器功能衰竭而死亡,治愈率为96.43%。结论血液灌流联合血液透析是抢救急性重症中毒的快速而有效的重要治疗方法。     

急性百草枯中毒18例分析

目的:探讨百草枯中毒的发病机制、临床表现和救治方法.方法:回顾性分析18例百草枯中毒的临床资料.结果:死亡14例,死亡率77.8%,其中11例死于多脏器功能衰竭.结论:百草枯中毒可导致多脏器功能衰竭,死亡率较高,及早进行血液灌流,大剂量糖皮质激素、免疫抑制剂的使用有助于提高抢救成功率.     

血液透析治疗鱼胆中毒致急性肾功能衰竭疗效观察

民俗进食鱼胆治疗咽喉肿痛、慢性支气管炎及眼病等,但鱼胆是具有较强细胞毒性的生物毒素,一旦过量中毒,病人即可出现多脏器功能损害,甚至多脏器功能衰竭,危及病人的生命。我院于2004年5月-2009年12月共收治9例口服鲫鱼胆致急性肾功能衰竭病人,采用血液透析治疗后全部痊愈出院,现将临床资料总结如下。     

急性百草枯中毒35例救治体会

目的：探讨急性百草枯中毒患者提高存活率的有效治疗方法。方法：对35例急性百草枯中毒患者的临床资料进行回顾性分析。结果：23例患者在院内因多脏器功能衰竭死亡,4例家属放弃治疗,后随访死亡,8例经强化综合治疗治愈,总病死率达77.1%。结论：急性百草枯中毒病死率极高,血液净化和应用大剂量激素的冲击早期治疗,可以延长患者生存时间,显著阻滞肺纤维化的发生,能提高患者的长期生存率,降低病死率。     

肾康注射液联合血液净化治疗蜂毒致急性肾功能衰竭9例临床观察

急性肾功能衰竭（ARF）的病因很多,生物毒素是致急性肾功能衰竭的原因之一,其中最常见的是鱼胆中毒和蜂蛰伤。这类患者病情往往发展迅速,多脏器功能受损严重,及时治疗可以痊愈,反之则可能发展成为慢性肾功能衰竭。我院于2009年1月至2012年3月,共收治蜂毒致急性肾功能衰竭甚至多脏器损害患9例,采用肾康注射液联合血液透析（HD）、血液透析滤过（HDF）进行治疗,取得满意效果,现报告如下。     

苯巴比妥负荷量防治新生儿缺氧缺血性脑病的用药时机

目的：分析苯巴比妥负荷量防治新生儿缺氧缺血性脑病的高效用药时机。方法：本研究选取某院2013-2016年间就诊的缺血缺氧性脑病（HIE）患儿169例进行研究，回顾性收集患儿治疗方案，并根据不同治疗方案将受试对象分为3组：A组患儿51例：24 h内使用负荷量苯巴比妥进行预防干预；B组患儿50例：24 h后使用苯巴比妥负荷量预防干预；C组患儿68例：未进行苯巴比妥负荷量预防，为对照组。收集患儿入院时基本情况，以及随访预防干预HIE的病情表现和预后状态，同时进行美国新生儿急性生理学评分国产期补充Ⅱ（SNAPPE-Ⅱ）的评分评价。讨论苯巴比妥负荷量防治新生儿缺氧缺血性脑病的最佳用药时机。研究中的数据均应用SPSS 20.0统计软件包进行分析。结果：本研究入院时3组患儿的SNAPPE-Ⅱ评分差别也无显著性差异。随访A组受试对象意识恢复最快，而C组最慢，P<0.05；反射和肌张力恢复时间也表现为A组最快而C组最慢，P<0.05；3组患儿随访SNAPPE-Ⅱ评分差别有显著性差异，P<0.05；A组评分水平最优，C组最差。同时统计患儿随访死亡发生情况，A组未检出死亡病例，B组和C组死亡率分别为2.00%和11.76%，C组岁最高，A组最低。结论：24 h内使用苯巴比妥负荷量防治新生儿缺氧缺血性脑病是一个高效的治疗时机，可有效改善患儿临床症状，并改善预后，减低死亡风险，值得临床推荐。     

The effect of phenobarbital and carbamazepine on the ethanol withdrawal reaction in the rat

The effects of phenobarbital (PB) and carbamazepine (CZ) on the ethanol withdrawal reaction in the rat were investigated in a blind study including an untreated control group. Physical ethanol dependence was established by intragastric intubation during a 4-day period. Both the degree of intoxication and the withdrawal reaction were assessed by standardised assessment instruments. Treatment with PB (40–60 mg/kg) and CZ (80–120 mg/kg) was initiated 10 h after the last ethanol dose and continued during the first 24 h of withdrawal. Serum concentrations of the drugs were measured.Both PB and CZ significantly reduced the ethanol withdrawal reaction compared to controls, and PB was significantly more effective than CZ. The degree of drug intoxication signs assessed by the same rating scale as the degree of ethanol intoxication indicated that maximum tolerable drug doses were used.PB probably exerts its treatment effect through the mechanism of cross dependence with ethanol, while CZ may exert a more specific effect on limbic structures responsible for central nervous system excitability.Abbreviations ANOVA analysis of variance - BEC blood ethanol concentration - CIS cumulated intoxication score - CZ carbamazepine - ICS incomplete clonic seizure - PB phenobarbital     

双重滤过血浆置换治疗吉兰-巴雷综合征与视神经脊髓炎的疗效观察

目的 观察比较全血浆置换(PE)与双重滤过血浆置换(DFPP)对吉兰-巴雷综合征(GBS)与视神经脊髓炎(NMO)的治疗效果及不良反应情况.方法 选取解放军第174医院2014年5月至2016年12月17例神经系统免疫性疾病患者,其中GBS 10例,NMO 7例,所有患者均符合诊断标准.17例患者随机分为2组,PE组8例(GBS 5例,NMO 3例),DFPP组9例(GBS 5例,NMO 4例),2组患者在性别、年龄及疾病严重程度评分上差异无统计学意义(P＞0.05).PE组行全血浆置换25例次,DFPP组行双重滤过血浆置换27例次,2组均采取隔日一次血浆置换的方法,观察2组患者进行血浆置换治疗后肌力、视力恢复情况,皮肤瘙痒、低血压等不良反应发生情况,血浆免疫球蛋白、补体和纤维蛋白原变化情况.结果 2组患者的肌力、视力均获得改善.PE组总体有效率75％,DFPP组总体有效率88％,2组有效率比较差异无统计学意义(P＞0.05).DFPP组患者治疗后补体、免疫球蛋白及纤维蛋白原较治疗前均明显下降(P＜0.05).PE组有3例出现输血反应,DFPP组有1例并发感染,1例并发出血.结论 PE及DFPP均能有效地治疗神经系统免疫性疾病,临床上如血源供应紧张或患者对异体血浆不能耐受,可选择行双重血浆置换治疗,但需注意预防出血及感染等不良反应.     

Convulsive behaviour during alcohol dependence: discrimination between the role of intoxication and withdrawal

Male Wistar rats were subjected to repeated weekly episodes of 2 days severe alcohol intoxication (intragastric intubation) and 5 days of withdrawal. In half of the animals the withdrawal reaction was attenuated during the first nine weekly episodes by intragastric intubations with phenobarbital. During episodes 10–14 both phenobarbital treated and phenobarbital untreated animals were allowed to develop a withdrawal reaction; all animals were video-recorded during withdrawal and the records were rated blindly for the occurrence of convulsive seizures. The results were analyzed by stepwise logistic analysis of regression including phenobarbital treatment, alcohol dose and intoxication score as explanatory variables for the occurrence of convulsive seizures. The animals that had been in withdrawal during all episodes developed significantly more convulsive seizures compared with animals that had their first nine withdrawal episodes attenuated by phenobarbital. The development of withdrawal seizures depended on repeated episodes of withdrawal, whereas repeated alcohol intoxication per se did not explain the development of seizures. There were no differences between the groups in the severity of the non-convulsive signs of alcohol withdrawal. Thus the development of seizures and the non-convulsive signs of alcohol withdrawal may result from two pathogenetically different mechanisms: 1) seizures from a cumulative kindling-like effect over long time periods and 2) physical signs of alcohol withdrawal may reflect the degree of physical dependence during the most recent drinking bout.     

A 4-year study of lithium intoxication reported to the Czech Toxicological Information Centre

Objective To evaluate the frequency and severity of lithium intoxication in calls to the Czech Toxicological Information Centre (TIC).Method A 4-year retrospective study (2000–2003) of cases of lithium intoxication. Analysis of data from the database of the TIC and hospital discharge reports: sex, age, dose, blood level and biochemical markers of nephrotoxicity, symptoms, treatment and outcome of intoxication.Results The TIC received 70 calls concerning lithium intoxication, but only 27 discharge reports from hospitals were obtained and evaluated. Calls concerning women (16, median age 43.5 years) were more frequent than calls concerning men (11, median age 51.0 years). 16 patients had central nervous system or neurological symptoms. Signs of nephrotoxicity were present in 10 patients. Nine patients had cardiovascular symptoms. Possible interactions with other drugs during chronic overdoses were present in 14 patients. Six patients died due to lithium intoxication.Conclusion Lithium intoxication remains a serious problem in calls to the TIC. Severe symptoms mainly developed in older patients. Drugs significantly potentiating toxic reactions to lithium should be avoided.     

Protection with butylated hydroxytoluene and other compounds against intoxication and mortality caused by hexachlorophene

The antioxidants butylated hydroxytoluene (BHT) and ethoxyquin protected rats against intoxication and mortality normally produced by hexachlorophene (HCP, 100 mg/kg). BHT also prevented the elevation of cerebrospinal fluid pressure, a central nervous system effect of HCP poisoning. In addition, both phenobarbital and SKF-525A protected against HCP poisoning, with the barbiturate also offering significant protection against triethyltin. L-Ascorbic acid, vitamin E, N,N-diphenyl-p-phenylenediamine and reduced and oxidized glutathione over a range of doses were ineffective in preventing HCP lethality. The protective effect of phenobarbital against HCP and triethyltin intoxication further supports existing evidence of a common or similar mechanism of toxic action for these two structurally dissimilar compounds.     

2型糖尿病合并植物神经病变患者心率变异性变化的临床意义

目的 :探讨 2型糖尿病 (T2DM)合并植物神经病变患者心率变异性 (HRV)变化的临床意义。方法 :对 2 2例合并植物神经病变的T2DM患者、2 1例单纯T2DM患者及 2 0例正常对照组进行了临床资料和HRV变化的研究。结果 :T2DM患者各时域及频域分析指标均较正常组降低 (P <0 .0 5或P <0 .0 1)。结论 :T2DM患者存在HRV异常 ,合并植物神经病变患者异常更显著 ,HRV分析是衡量T2DM患者植物神经病变有效的客观指标 ,能较全面直观定量反映出T2DM合并植物神经病变患者心血管交感神经及迷走神经的功能状态     

The clinical picture of olanzapine poisoning with special reference to fluctuating mental status

BACKGROUND: Olanzapine is an atypical antipsychotic drug that is increasingly used in intentional drug overdoses. Although acute olanzapine overdose is predominantly associated with anticholinergic symptoms and central nervous system depression, miosis and unpredictable fluctuations between somnolence/coma and agitation/ aggression have been suggested as typical signs of olanzapine intoxication in single case reports. AIMS: To confirm the suggestion that fluctuating central nervous system changes and miosis are characteristic signs of olanzapine intoxication. To estimate the dose-response relationship as a guide for the provision of optimal management of olanzapine intoxicated patients. METHODS: Retrospective analysis of all well-documented cases of olanzapine intoxication reported to the Swiss Toxicological Information Centre between January 1997 and October 2001. Inclusion criteria for detailed analysis were patient age > or = 16 yr, acute olanzapine monointoxication, ingested dose > 20 mg, and a causal relationship between olanzapine overdose and clinical effects. The Poisoning Severity Score of the European Association of Poison Centres and Clinical Toxicologists (EAPCCT) assessed the intoxication severity. RESULTS: Out of a total of 131 cases of olanzapine overdose, 26 cases fulfilled the inclusion criteria. The ingested olanzapine doses ranged from 30 to 840 mg. The most frequent findings were somnolence (77%), agitation (42%), and miosis (31%). The Poisoning Severity Score was "minor" in 14 (54%), "moderate" in 11 (42%), and "severe" in 1 (4%) patients. Nine patients (35% of all patients) with moderate olanzapine poisoning (120-840 mg) showed unpredictable fluctuations between somnolence and agitation. Five of these patients also demonstrated marked miosis. All patients recovered within 48h. One patient with severe poisoning (560 mg) had coma and convulsions. Moderate (and severe) symptoms occurred only at ingested doses above 120 mg. There was a statistically significant association between increasing ingested olanzapine doses and poisoning severity. CONCLUSIONS: Although olanzapine is tolerated relatively well in acute overdose, unpredictable and transient fluctuations between central nervous system depression and agitation, frequently associated with miosis, appear to be characteristic findings in moderate to high olanzapine overdoses. They are transient in nature and require careful clinical monitoring but rarely require specific therapeutic interventions.     

多潘立酮多虑平治疗功能性消化不良

目的 探讨多潘立酮及多虑平联合应用治疗功能性消化不良的疗效。方法 把功能性消化不良患者90例随机分配入二组，多潘立酮及多虑平联合治疗组，多潘立酮和安定联合治疗组。观测治疗前后的消化系统症状，并进行t检验。结果 多潘立酮及多虑平联合治疗功能性消化不良取得满意疗效。患者消化系统症状明显改善，尤其是腹胀症状缓解有效率达88％，嗳气、烧心症状缓解率达84．2％，两组差别有高度显著性（P〈0.01）。结论 多潘立酮及多虑平联合治疗功能性消化不良有效率较高，疗程短，不良反应小。     

Analysis of haemoperfusion columns for evaluation of treatment of phenobarbital overdosage

A simple procedure for the extraction of phenobarbital from charcoal haemoperfusion columns is presented. This method enables to evaluate the efficacy of treatment of poisoned patients with haemoperfusion. The applicability of this procedure is tested with four columns which were used in the treatment of two patients with severe phenobarbital intoxication. When an appropriate internal standard and solvent are used, this method is applicable for any drug.