急性中毒昏迷患者洗胃的研究进展

综述近年来急性中毒昏迷患者洗胃的研究进展,从而根据患者情况选择合适的洗胃方法,以最大限度地减少并发症对机体造成的损害,提高抢救成功率。     

改良洗胃术在急性有机磷中毒治疗的应用现状

有机磷酸酯类化合物是农业生产中普遍应用的杀虫剂,因其广泛供应为故意和偶然中毒提供了重要机会。该类杀虫剂毒性强吸收快,并发症多,一旦入侵机体,即可产生强烈的毒性反应,如不及时予以干预,将对患者的生命安全产生极大的威胁,因此尽快清除毒物,阻止毒物内吸收是救治成功的关键。近年来,随着对有机磷中毒综合治疗研究的不断深入,发现洗胃有着举足轻重的作用,但对于高效清除胃内毒物的有效措施及方法仍存在争议。本文就洗胃的必要性、洗胃管的置入、洗胃体位、洗胃液选择、洗胃法设置作一综述,以期为日后建立和规范有机磷中毒洗胃救治提供参考。     

心肺复苏状态下剖腹洗胃抢救重度有机磷中毒的体会

洗胃,清除胃内尚未被吸收的毒物,是抢救急性有机磷中毒的根本措施。本文拟结合1例重度有机磷中毒致心跳呼吸停止,行心肺复苏、剖腹洗胃急救的经过,浅谈一点体会。     

录音呕吐情境想象对急诊口服洗胃的影响

目的 探讨录音呕吐情景想象对急诊口服洗胃的影响.方法 按便利取样法将40例急诊口服洗胃患者分为实验组20例和对照组20例,实验组接受常规护理和录音呕吐情景想象,对照组则接受常规护理.观察两组洗胃过程时间,配合效果及胃储留的情况.结果 实验组洗胃过程时间比对照组提前了11.46分钟,差异有显著性意义,实验组洗胃过程配合明显优于对照组,胃储留的情况也略少于对照组.但无统计学意义.结论 录音呕吐情景想象作为护理干预措施,可大大减少洗胃的时间,配合度增加.     

两种洗胃法在36例中毒急救中的临床对比分析

口服中毒是近年来急诊常见的病种之一，分自服和误服两种情况，常见的有药物、有机磷农药、各种清洁剂、药酒、鼠药等中毒。中毒人群年龄分布从1岁至70岁。为了使毒物尽快排出体外减少吸收，最快速有效的办法就是洗胃。本文现只探讨药物中毒时不同洗胃法在不同年龄段的安全性及实用性。     

30例儿童误服毒鼠强中毒的急救护理体会

目的：总结30例误服毒鼠强中毒患儿的急救护理体会。方法：对毒鼠强中毒的患儿及时洗胃，充分清除胃内尚未吸收的毒物，防止毒物进一步吸收，迅速建立静脉通道，及时予以对症治疗，加快毒物的排泄；密切观察病情变化，加强基础护理，做好心理护理和健康宣教工作。结果：通过急救与护理措施30例中毒儿童均获康复出院。     

急性异烟肼中毒误诊6例

急性异烟肼中毒误诊在临床上比较少见,笔者根据收治的6例报道如下。 1 临床资料 笔者从1970年到1996年共收治急性异烟肼中毒误诊6例。6例均为女性,年龄17～42岁,平均26.8岁。服毒到就诊时间为1/2～1h,误诊时间为2～4h,被误诊为癫痫2例,病毒性脑炎3例,急性氨茶硷中毒1例。患者血常规、尿常规、肝功能均正常,心电图:窦性心动过速2例,正常4例。     

急性有机磷农药中毒患者留置胃管反复洗胃76例

目的彻底净化急性有机磷农药中毒患者的胃肠道,提高救治成功率。方法对76例重度急性有机磷农药中毒患者首次洗胃后留置硅胶胃管24～48h,每6h重复洗胃一次,洗胃量10～20L,洗胃液为温开水。结果76例患者,治愈72例,治愈率为94.7%,死亡4例,死亡率为5.3%。结论保留胃管反复洗胃,能有效地减少有机磷的重吸收,防止出现反跳及中间综合征,从而提高救治成功率。     

急性有机磷中毒的毒物清除问题

急性有机磷中毒是急诊科常见的中毒病例，病情凶险，死亡率高。对于此类患，迅速有效地清除毒物，是应急的关键。     

护理流程在有机磷农药中毒患者留置胃管反复洗胃的总结

急性有机磷农药中毒（AOPP）患者死亡率较高,死亡患者有20％与洗胃不彻底有关。有研究发现,经口服急性有机磷农药中毒患者在彻底洗胃后数小时,胃内仍有大量农药成分,其含量与血浆中农药含量成正相关。过去本院强调一次性彻底洗胃并常规导泻,临床效果不显著。2003年1月～2007年1月本院对重度急性有机磷农药中毒患者,采取首次洗胃后留置硅胶胃管（德尔DRW型胃管26F）24～48h反复洗胃,取得满意的效果,现报告如下。     

Neuropathology of intramural autonomic innervation of mice stomach in chronic ethanol intoxication

Intramural stomach innervation was investigated in DBA mice after 1 week, 6 weeks and 3 months of intragastric ethanol treatment (1 cm3 daily by plastic tube). The results indicated that the intramural nervous system of the stomach underwent ultrastructural and histological changes in relation to ethanol. Alterations were noticeable after 3 weeks of treatment. They were more strongly pronounced after 6 weeks and were maximally advanced in the group with 3 months of ethanol treatment. Mitochondria seemed to be first affected, especially in the axonal processes and nerve endings (higher density, hypertrophy, inverted pattern of cristae). Dense bodies with double membrane as well as altered fibrocytes and myocytes were noticed after longer periods of intoxication. Ischemic disease of neurons developed after 3 months of ethanol administration, probably against the background of severe mitochondrial damage. Some features suggested reconstruction of the cell population in intramural ganglia.     

Function of the motor apparatus of the stomach in experimental lead intoxication

Summary It was established in chronic experiments on dogs that the picture of experimental lead poisoning was to a considerable extent similar to that seen during clinical manifestations of saturnism in human beings. This similarity was manifested by the intermittent character of its course, i.e., repeated changes of aggravation (correspondingly exacerbation) and amelioration (correspondingly lead carrier state) periods. Registration of the motor function of the stomach in these animals indicated that its disturbances in chronically intoxicated animals also had a course with alternating periods of aggravation and normalization. Obvious lead intoxication was also accompanied by a marked depression of the motor function of the stomach.(Presented by Member of the Academy of Medical Sciences of the USSR V. V. Parin) Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 61, No. 5, pp. 36–40, May, 1966     

mTOR抑制剂抗动脉粥样硬化的研究进展

雷帕霉素靶蛋白(m TOR)是哺乳动物细胞中的Ser/Thr激酶,存在m TORC1和m TORC2两种复合体,调控细胞增殖、迁移及血管生成。大环内酯类免疫抑制剂雷帕霉素(RAPA)及其衍生物(rapalogs)可抑制m TORC1的功能,减缓动脉粥样硬化(AS)的发生发展。然而长期应用rapalogs会导致m TORC1抵抗及m TORC2抑制,产生血脂异常等。临床上采取联合用药、间歇性给药或低剂量给药等措施应对。     

Arteriography of three models of gastric oesophagoplasty: the whole stomach, a wide gastric tube and a narrow gastric tube

The esogastric anastomotic fistula,occurring after the replacement of esophagus by the stomach, is a post-operative complication always feared and awaited. Apart from other causes, there exist the anatomical dispositions notably the vascular and technical factors that stress this potential risk despite certain advantages of esophagogastroplasty. The goal of our study was to study the arterial distribution of the gastric transplants in order to identify the better modalities of their making. We used 39 stomachs taken from fresh cadavers of autochtone subjects. After a modeling treatment using three different techniques, they were subjected to a radiographic opacification of the right gastro-epiploic artery with sulphate of barium follow by an x-rays in incidence full-face (25 kv, 10 mAS). It was a matter of 15 entire stomachs (E.E.) with denudation of the small curvature, of 12 wide gastric tubes (W.T.) prepared according to the Akiyama technique modified and of 12 narrow tubes (N.T.) tubulized according to the Marmuse method. We studied the anastomotic type of the gastro-epiploic arterial circle according to the classification of Koskas, the collateral branches of the arterial circles of the gastric curvatures, the antral and corporeal anastomosis of these circles and the distribution anastomotic at the level of the summit of the anastomotic. Only 28 pieces (15 E.E., 8 W.T. and 5 N.T.) were able to be the object of a complete angiographic exploitation. The anastomosis of the arterial circle was type I in 64.1% of the cases, type II in 15.4% of the cases, type III in 15.4% of the cases and type IV in 5.1% of the cases. The average number of collateral branches originating from gastro-epiploic arterial circle was respectively 24, 17 and 22 for the E.E., the W.T. and the N.T. Only the two first ones presented collateral branches being borne of the small curvature circle. Fifty per cent of the N.T. did not possess any antral or corporeal anastomosis between the two arterial circles; some of them were even for a quarter of the W.T. In the case of gastric tubulization there existed an irrigation defect of the summit of the plasty for a third of the N.T. and a quarter of the W.T., despite a constant intramural bridge anastomosis between the two gastro-epiploic arteries. The usage of the entire stomach must be recommended for gastric oesophagoplasty; but when the operative indications require a resection of the small curvature it is preferable to use a wide gastric tube whose diameter respects the two left third of the initial width of the organ.     

不同洗胃时间对新生儿咽下综合征的疗效观察及护理

目的 探讨不同洗胃时间对新生儿咽下综合征的疗效影响.方法 对142例患儿随机分成两组,A组(80例)在出生后＜12h、B组(62例)在出生后12h～24h进行洗胃,观察各组呕吐持续时间,出生24 h内低血糖发生率,第1次胎粪排出及胎粪转黄时间,结果 洗胃时间越早,呕吐持续时间越短,低血糖发生率越低,胎粪排出、排尽的时间越短,各组间差异有显著性.结论 采取早期洗胃治疗新生儿咽下综合征有利于疾病恢复,越早治疗效果越好,且副作用少.     

胚胎发育生物标志物的研究进展

筛选高质量配子和高发育潜能胚胎是辅助生殖技术关注的重点。近年研究发现胚胎培养液中含有胚胎分泌的蛋白、游离DNA片段、细胞因子等,胚胎也从培养液中获取胚胎发育所需的营养物质。通过分析胚胎培养液成分,运用无创的方法,利用胚胎代谢组学、蛋白组学等方法快速、准确筛选出最具有发育潜能的优质胚胎。本文总结氨基酸、碳水化合物、细胞因子和蛋白质等物质对胚胎发育的影响。     

免疫检测信号放大技术研究进展

随着疾病早期诊断及生物标志物开发、功能界定等需求的出现,免疫检测技术的灵敏度不足这一问题日益显著,如何提高检测灵敏度去突破瓶颈成为现在生物分析领域的一个重大挑战。对检测信号进行放大是提高检测灵敏度最直接的一种方法。生物素-亲和素系统(biotin-avidin system,BAS)、酪胺信号放大技术(tyramide signal amplification,TSA)以及免疫-聚合酶链反应(immuno-polymerase chain reaction,Im-PCR)是较为经典的信号放大技术,可显著提高免疫检测的灵敏度。近年来,研究发现,基于催化信号分子沉淀的信号放大技术、基于纳米颗粒的信号放大技术及基于杂交链式反应的信号放大技术等信号放大手段的出现,使得免疫检测的灵敏度可以进一步提高3个数量级。本文将针对近年来研究较多的几种用于免疫检测信号放大的技术进行总结,并对其优缺点进行比较分析,以期为已开发的信号放大技术向临床转化及进一步开发超高灵敏度的免疫学检测技术提供参考。