急性有机磷农药中毒性肺水肿临床分析

目的：探讨有机磷农药急性中毒并发急性肺水肿的发病机理、临床特点、影像学特征及治疗。方法：回顾分析1995年1月～2006年1月间，经抢救和治疗的66例有机磷农药中毒并发急性肺水肿患者的症状、胸部X线、诊断及治疗结果的临床资料。结果：本组病例均系急性有机磷农药中毒。主要症状包括干咳或咳泡沫痰、胸闷或呼吸困难、咯血及胸腔积液。早期肺部体征阴性，肺泡性肺水肿期两下肺可听到湿性哆音。本组病例在肺淤血期和间质性肺水肿期的X线表现早期不明显．直到肺泡性水肿才表现特征性改变。全部病人均在大剂量氯磷定、阿托品及对症治疗的基础上。加用利尿脱水剂、皮质激素、抗生素，重者给予呼气未正压呼吸（PEEP）给氧等治疗。66例患者中58例（87．9%）治愈好转出院，死亡6例，占9．1茗。其中死于肺水肿致呼吸衰竭3例（4．6%）。结论：急性有机磷农药中毒并发急性肺水肿是一严重临床表现。临床特点和X线表现早期表现不明显，易被中毒的其它全身表现所掩盖。在治疗措施上，既要针对肺水肿的临床表现，又要考虑到原发疾病的病因治疗。与心源性肺水肿治疗有不同的地方，临床医生应引起足够重视。     

60例有机磷农药急性中毒并发急性肺水肿分析

目的：探讨有机磷农药急性中毒并发急性肺水肿的发病机理、临床特点、影像学特征及治疗方法。方法：回顾分析2004年1月-2006年11月间，经抢救和治疗的60例有机磷农药中毒并发急性肺水肿患者的的症状、胸部x线、诊断及治疗结果的临床资料。结果：本组病例均系急性有机磷农药中毒。主要症状包括干咳或咳泡沫痰、胸闷或呼吸困难、咯血及胸腔积液。早期肺部体征阴性，肺泡性肺水肿期两下肺可听到广泛湿性罗音。本组病例在肺淤血期和间质性肺水肿期的X线表现早期不明显，直到肺泡性水肿才表现特征性改变。全部病人均在应用氯解磷定、大剂量阿托品及对症治疗的基础上，加用甘露醇、速尿利尿脱水剂、皮质激素、抗生素，重者给予呼气末正压呼吸（PEEP）给氧等治疗。60例患者中51例（84．6％）治愈好转出院，死亡9例，占15％。其中死于肺水肿致呼吸衰竭3例（5．8％）。结论：急性有机磷农药中毒并发急性肺水肿是一严重临床表现。临床特点和X线表现早期表现不明显，易被中毒的其它全身表现所掩盖。在治疗措施上，既要针对肺水肿的临床表现，又要考虑到原发疾病的病因治疗，临床医生应引起足够重视。     

有机磷农药急性中毒并发肺水肿60例临床分析

<正>有机磷农药的应用日趋广泛,有机磷农药急性中毒的病例也相应增多。但急性有机磷农药中毒并发急性肺水肿,尚未引起临床上应有的重视。本文就其发病机理及诊断、治疗问题,结合临床资料作     

有机磷农药中毒24例临床分析

目的：探讨有机磷农药中毒的主要临床特点及治疗方法。方法：回顾性分析作者医院2004年3月至2006年9月收治的有机磷农药中毒24例临床特点及疗效。结果：治愈20例（占83．33％），死亡4例（其中3例死于急性肺水肿，1例死于反跳。结论：有机磷农药的早期诊断，尽早彻底洗胃，使用阿托品，综合支持治疗均直接与疗效相关。     

床旁胸片评价急性心肌梗死患者并发肺水肿

目的 观察床旁胸片中急性心肌梗死患者并发肺水肿的影像特点,评价其诊断价值.方法 回顾分析103例急性心肌梗死患者床旁胸片表现及临床资料.结果 34例(33%)有肺水肿影像表现,其中肺纹理模糊和肺门影增大、模糊34例(100%),间隔线11例(32.3%),支气管袖口征8例(23.5%),胸膜下水肿7例(20.6%),少量胸腔积液6例(17.6%).结论 床旁胸片是诊断肺水肿重要而有效的检查手段.肺纹理模糊和肺门影增大、模糊为肺水肿在床旁胸片中的重要征象.     

急性中毒性肺水肿CT影像改变与早期诊断价值

目的：分析急性中毒性肺水肿的CT影像改变，探讨其早期诊断价值。方法：回顾分析1997年以来经临床、X线、CT影像观察确诊为急性中毒必肺水肿22例，常规采用横断面CT平扫，详细分析了它们的CT影像改变。结果：急性中毒性肺水肿CT影像改变分为间质型肺水肿和肺泡型肺水肿两类，其早期诊断价值明显优越于常规X线胸部摄片。结论：根据CT影像改变，早期又作出急性中毒性肺水肿诊断，对临床采取及时、有效治疗有特别重要临床意义。     

关于有机磷急性中毒并发急性肺水肿问题：附861例分析

有机磷农药的应用日趋广泛,因之,近年来发生有机磷急性中毒的病例亦相应增多。此种中毒来势凶猛,发展迅速,死亡率高,抢救必须分秒必争,及时果断有效。一些严重中毒患者的死亡,多因抢救不及时,或抢救措施不得当而造成。一般性临床抢救措施已为临床医护人员所熟知,并各自积累了许多宝贵经验。但有机磷中毒并发急性肺水肿,这一严重临床表现,尚未引起应有的重视。本文就其发病机制及治疗问题,结合我们的临床资料作如下讨论。     

血液透析患者并发尿毒症肺52例

目的：探讨维持性血液透析患者并发尿毒症肺的原因、临床特点及治疗方法。方法：对我院2002年7月至2006年5月血液透析患者并发尿毒症肺52例的临床特点、X线表现、实验室检查、治疗与转归情况进行总结分析。结果：尿毒症肺的常见临床表现为咳嗽、咳痰、呼吸困难、咯血、肺部湿性罗音；X线表现以肺淤血、间质性肺水肿常见：实验室检查多有血白细胞计数不高、血红蛋白及白蛋白低、代谢性酸中毒、低氧血症；经增加透析次数等处理。症状或体征消失39例。好转12例。死亡1例，其中27例2周后复查胸片基本正常22例，好转5例。结论：尿毒症肺是尿毒症患者非感染性的肺部常见并发症。以充分透析为主的综合治疗可有效降低尿毒症肺的发生。     

强直性脊柱炎并发葡萄膜炎的诊断及治疗(附16例报告)

[目的]探讨强直性脊柱炎并发葡萄膜炎的诊断和治疗。[方法]对16例确诊强直性脊柱炎并发葡萄膜炎患者的症状、X线表现、实验室检查结果进行分析,总结其临床特征和治疗方法。[结果]16例患者（16只眼）均为急性前葡萄膜炎,葡萄膜炎的平均发病年龄为32岁,均有葡萄膜炎复发史,双眼受累者10例（62.5%）,均为单眼交替发病。所有患眼均表现为急性非肉芽肿性前葡萄膜炎;葡萄膜炎平均持续时间为4周。X线检查均有轻重不等的骶髂关节炎改变,13例患者HLA-B27阳性（81.3%）,经睫状肌麻痹剂和糖皮质激素眼液治疗后14只眼最佳矫正视力≥1.0。[结论]对于合并有腰骶痛及关节症状的急性前葡萄膜炎患者进行X线及HLA-B27检查,有助于早期确诊强直性脊柱炎。强直性脊柱炎并发葡萄膜炎经睫状肌麻痹剂和糖皮质激素滴眼等综合治疗预后良好。     

急性肺水肿误诊为肺炎10例X线平片对照分析

急性肺水肿和急性支气管肺炎在 X线平片上有其各自的典型表现。不典型的急性肺水肿 X线平片往往表现为类似支气管肺炎的 X线征象。现就我院 1998～ 2 0 0 0年 10例 X线误诊分析如下。1　对象和方法本组男 7例 ,女 3例 ,男女之比为 2 .6∶ 1。年龄最大为 71岁 ,最小为 11岁 ,平均年龄 41岁 ,误诊治疗不当死亡 1例。本组经临床及病理证实 ,均为不同程度的间质性肺水肿和肺泡性肺水肿并存 ,以肺泡性肺水肿占主要因素的 9例 ,合并心力衰竭 4例 ,肾功能衰竭 3例 ,症状表现为急性或仅见轻度低热。表现严重的为气急、气短、不安、心悸 ,2例以间质…     

对急性气体中毒治疗的新认识

目的：总结急性气体中毒的临床特点和治疗体会。方法：利用急性中毒调查表分析57例急性气体中毒病人的毒物接触史、临床情况。结果：本组病人20岁至29岁年龄组占比例最高(57.9％)，防护不周引起中毒占93．0％，一氧化碳(32．2％)居毒物种类首位，油漆(30．5％)其次，共有13例出现并发症(22．8％)，死亡5例(8．8％)。结论：有毒有害气体引起中毒危害最大的是化学性肺水肿和中毒性脑病，急性气体中毒强调综合性治疗，预防措施包括加强企业安全劳动防护制度管理，生产作业安全操作等。     

百草枯中毒的胸部CT影像表现分析

目的：探讨百草枯中毒的胸部CT影像表现特征.方法：回顾分析2003年1月-2013年2月10例百草枯中毒患者的胸部CT资料.结果：10例患者中,2例（20％）轻度中毒患者胸部CT检查为阴性,8例（80％）患者胸部CT检查为阳性.8例胸部CT检查阳性的患者中,4例中中毒患者的早期表现为两肺下叶磨玻璃影,后期逐渐发展为两肺间质纤维化;另4例重度中毒且死亡患者的早期表现为两肺肺纹理增多及磨玻璃影,中期逐渐发展为两肺片状实变影,晚期出现胸腔积液、肺水肿、心包积液.结论：胸部CT检查对百草枯中毒患者的诊断和预后有重要价值.     

急性有机氟气体中毒患者呼吸系统损害的特点分析

目的：分析急性有机氟中毒患者呼吸系统损害的特点。方法：回顾性分析我院2011年集中收治的22例急性有机氟中毒患者的临床资料,着重分析患者的呼吸系统症状、肺部体征、影像学表现、肺功能的影响。结果：有机氟气体中毒呼吸系统损害主要表现为胸闷、气喘、咳嗽、呼吸困难,影像学特征为两肺渗出性病变、急性肺水肿,可并发纵N／皮下气肿,后期可以出现肺纤维化且为可逆,对肺功能、劳动能力的影响轻微。结论：有机氟气体所致的肺损伤具有“隐匿性、爆发性、致死性”的特点,临床工作中要保持高度警惕,有条件尽可能行CT检查,并至少要留观72h,做到早诊断、早治疗,一般预后良好。     

百草枯中毒死亡的临床病理分析

目的分析百草枯中毒死亡的临床及病理学特点,探讨百草枯中毒致肺纤维化的损伤机制。方法对2010年1月一2013年12月涉及百草枯中毒的3例死亡案例进行回顾性分析,观察对比急慢性百草枯中毒死亡的临床特点及病理学改变。结果百草枯中毒的临床及病理表现主要是以肺为靶器官的多器官损伤,急性中毒死亡者肺损伤主要为肺水肿及肺透明膜形成,慢性中毒死亡者肺损伤主要为肺透明膜形成及广泛肺间质纤维化。结论临床上应加深百草枯中毒表现及损伤机制的认识以对患者进行早期诊治。而法医学鉴定应结合案情、临床资料、毒物分析及解剖结果进行综合分析而得出正确的鉴定结论。     

急性酒精中毒对心脏损害75例临床分析

我院于2000年12月至2005年12月救治103例急性酒精中毒患者,其中有75例并发不同程度的心脏损害,占103例急性酒精中毒病人的79.82.%,仅次于对神经系统的损害。现分析如下。1临床资料1.1一般资料急性酒精中毒合并心脏损害75例,男性63例,女性12例,年龄29~42岁(平均29±5岁)。就诊时     

Diagnosis in an acute organophosphate poisoning: report of three interesting cases and review of the literature.

Organophosphates may cause serious life-threatening conditions, such as an initial acute cholinergic crisis and intermediate syndrome. Each of these conditions has a potential for respiratory failure requiring ventilatory support. For this reason, it is very important to recognize them early, especially to institute appropriate management. The diagnosis of organophosphate poisoning is based essentially on a clinical assessment, followed by laboratory examinations. Sometimes the diagnosis may be difficult, as in case 1, identified initially as brainstem stroke. However, if neurological syndromes associated with organophosphate poisoning are well known, they can easily be distinguished from other conditions that resemble them. Two cases displayed the symptoms and signs of intermediate syndrome; however, one case (no. 2) did not have severe poisoning on admission but needed artificial ventilation. Each case recovered completely from organophosphate poisoning as a result of early diagnosis and appropriate therapy. Therefore, we would like to describe the clinical and laboratory features of these syndromes, observed in three interesting cases, and to emphasize the importance of early and accurate diagnosis for the appropriate management of acute organophosphate poisoning.     

老年人急性肺水肿为主要表现的急性心肌梗死44例临床分析

目的分析以急性肺水肿为主要表现的老年人急性心肌梗死（AMI）的临床特点，探讨其心力衰竭的发生机制。方法回顾性分析44例以急性肺水肿为主要表现的AMI老年患者的临床特点，根据NYHA心功能分级及超声心动图所示左室射血分数（LVEF）探讨AMI时发生急性肺水肿的机制。结果44例中，29例（65．9％）为无痛性梗死；32例（72．7％）为急性非透壁性梗死，7例并发完全性左束支传导阻滞；超声心动图LVEF〈40％26例，≥40％18例。随访24例，半年内死亡7例（29．2％）。结论以急性肺水肿为主要表现的AMI多为无痛性梗死，心电图表现多为急性非透壁性梗死。AMI时发生急性肺水肿的机制为左室收缩功能及舒张功能的严重损害。     

急性毒鼠强中毒71例分析

目的:为提高急性毒鼠强中毒的认识和抢救水平.方法:急性毒鼠强中毒患者71例,按职业性接触中毒和非职业性中毒(胃肠道途径)分类,分析救治措施和进行疗效统计.结果:非职业性(胃肠道途径)中毒者多在口服后10min至2h发病,主要表现为头昏、乏力、恶心、呕吐、重症者表现为抽搐(50例)、伴昏迷(23例)、休克(7例)、心律失常(24例)、急性肺水肿(14例)、呼吸衰竭(21例)和咯血(1例),服毒量越多,病情越重,职业中毒者症状均较轻;本组有14例死亡,病死原因均为呼吸衰竭,病死率与服毒量有关,青少年及老年人病死率高于青中年患者.结论:毒鼠强毒性强、可致多器官损害,重症患者病死率高,主要死亡原因为呼吸衰竭,救治过程中应强调早期彻底清除毒物,重症者宜早期予人工支持呼吸.     

Mortality rate and pattern following carbamate methomyl poisoning. Comparison with organophosphate poisoning of comparable toxicity

Context. Methomyl is a widely used carbamate insecticide. It is known that mortality rate is generally low in carbamate poisoning, but fatalities from methomyl poisoning have been reported. Nevertheless, there is no reported comparative outcome of methomyl and organophosphate poisoning of comparable toxicity concerning mortality rate and mortality pattern. Objective. This study aims to compare the mortality rate and pattern following methomyl poisoning with those after organophosphate poisoning of comparable toxicity. Material and methods. A retrospective study was conducted on patients with cholinesterase inhibitor poisoning admitted to our institution. Among a diverse group of cholinesterase inhibitors, we included patients who presented after ingesting methomyl or World Health Organisation hazard Class I organophosphate compounds. Patients were divided into two groups; the methomyl group and the Class I organophosphate group. Results. The methomyl group consisted of 17 patients, and the Class I organophosphate group consisted of 42 patients. Seven patients (41.2%) in the methomyl group presented with cardiac arrest, while none presented with cardiac arrest in the Class I organophosphate group (p < 0.001). In the methomyl group, patients who had not experienced cardiac arrest at presentation survived to discharge from hospital. Among the seven patients who presented with cardiac arrest, three died from multiple organ dysfunction syndrome after resuscitation from cardiac arrest. In the Class I organophosphate group, four patients died from pneumonia and complicating acute respiratory distress syndrome. Therefore, the mortality rate was 17.6% in the methomyl group and 9.5% in the Class I organophosphate group (p = 0.399). Conclusion. The mortality rate of methomyl poisoning was comparable to that of World Health Organisation Class I organophosphate poisoning. All died patients in the methomyl group experienced cardiac arrest, and died from multiple organ dysfunction syndrome after resuscitation from cardiac arrest.     

The Clinical Significance of Hyperamylasemia in Organophosphate Poisoning

Abstract

Objective: Hyperamylasemia with a presumptive diagnosis of acute pancreatitis has been reported following organophosphate poisoning but there are no large-scale studies incorporating more specific diagnostic criteria. Methods; Retrospective review of the medical records of 159 patients with a diagnosis of organophosphate poisoning over 3 years. Serum amylase, pancreatic amylase, salivary amylase, lipase and cholinesterase levels, and the clinical manifestations were analyzed. Results; Serum amylase data was available for 121 of the 159 study patients. Hyperamylasemia (amylase ≥ 360 U/L) was found in 44 patients (36%). Lipase was measured in 28 patients with hyperamylasemia; 9 of 28 had hyperlipasemia (lipase ≥ 380 U/L). The finding of hyperamylasemia was closely related to clinical severity and presence of shock. A presumptive diagnosis of painless acute pancreatitis was diagnosed by hyperlipasemia associated with hyperamylasemia, clinical severity, serum LDH, and leukocyte counts. Two patients with presumptive pancreatitis died. Shock, coma, and hypoalbuminemia were the factors predicting fatality. Conclusions: Hyperamylasemia is frequent in severe organophosphate poisoning. However, hyperamylasemia is not synonymous with acute pancreatitis and pancreatic amylase is not a reliable parameter in the diagnosis of organophosphate-induced pancreatitis due to its low sensitivity and specificity. Lipase assay is indicated in patients with hyperamylasemia for early diagnosis of pancreatitis. Proper image studies and even pathological examination are also needed to confirm the extent of pancreatic injury. With prompt diagnosis and appropriate treatment, a complete recovery can be anticipated unless the patient has otherwise unrelated complications.