小儿误服药物中毒的急诊救治

正小儿年幼无知,如果父母对家中的药物保管不妥或对孩子监护不够,以及不恰当地使用药物,有时就会造成小儿药物中毒。资料显示,小儿急性中毒其中有75%是药物中毒引起。小儿复方药药物中毒,随着复方药物的临床广泛使用已屡见不鲜,成为儿科门诊常见病种之一。就我科近年来对小儿复方药物中毒病例的急诊处理,结合典型病例的救治过程,报告如下:1 临床资料我院2005~2012年共救治小儿急性药物中毒96例,男56     

乌头碱中毒6例救治体会

乌头碱存在于川乌、草乌、附子、雪上一只蒿等多种草药中。这些草药大多数具有祛风除寒、温经止痛的功效。民间多用于强身健体、舒筋活血,治疗胃痛、腰痛、风湿性关节痛等。不少人认为中草药＂平和宜人＂＂安全无毒＂,大量或长期服药也不易引起中毒。其实不然,中草药使用不当也可发生毒副作用,甚至致死。2007年9月,我科共收治乌头碱中毒患者6例。现报告如下。     

23例毒蕈中毒救治体会

蕈俗称蘑菇，常被产地居民自采而食用。将毒蕈当作无毒蕈采集后食用，将引起毒蕈中毒，食用毒性极高的毒蕈，将导致中毒者死亡。我们对2006年7-8月在大连市内四所综合医院及一所专科医院收治的23例毒蕈中毒患者的临床表现及救治经过进行总结分析，报道如下。     

成功救治重度防冻液中毒1例

报告1例重度防冻液中毒的临床资料,探讨了乙二醇中毒的发病机制、临床表现及治疗原则。 更多还原     

47例急性光气刺激反应及其救治

目的 总结急性光气刺激反应的临床表现及综合性救治的临床疗效.方法 回顾分析本医疗中心2007年11月至2009年7月救治的47例急性光气刺激反应患者的临床症状、体征、血氧饱和度和X射线胸片等临床资料.结果 采用糖皮质激素(必可酮喷雾剂)+吸氧等常规治疗后,患者临床症状、体征等均获得明显好转.结论 急性光气刺激反应引起的急性呼吸道及眼部刺激症状,通过糖皮质激素喷雾、小剂量低流量持续吸氧为主的综合治疗,可以在短时间内得到缓解、痊愈.     

某院大门诊建设的实践与体会

通过江苏省中医院近年来在“大门诊”建设中的实践,从树立发展理念、加强内涵建设等方面进行了阐述。同时分析了“大门诊”目前存在问题,并提出了改进建议。     

纳络酮、氟吗西尼与联合使用纳络酮与氟吗西尼治疗急性安定中毒的疗效和安全性比较

目的观察纳络酮、氟吗西尼、联合使用纳络酮和氟吗西尼治疗急性安定中毒的疗效和安全性.方法将45例安定中毒患者随机分为纳络酮组(15例)、氟吗西尼组(15例)和联合使用纳络酮、氟吗西尼治疗组(15例).三组患者在常规治疗相同情况下,在相同时间内分别用纳络酮、氟吗西尼、纳络酮和氟吗西尼治疗,对三组患者,在治疗0、5、15、60、90、180min进行镇静催眠评分,并作相关的常规及生化检查,持续监测患者生命体征、氧饱和度.结果联合用药组的早期治疗有效率高于单独使用纳络酮组(P＜0.05),但观察终点治疗有效率无显著性差别.镇静催眠评分比较,使用氟吗西尼的两组在治疗过程中均要低于纳络酮组,联合使用两种药物治疗组更低,且有显著性差异.三组并发症比较无明显差异.结论纳络酮,氟吗西尼都是治疗安定类药物中毒的有效药物,联合使用纳络酮和氟吗西尼是疗效体现更早、最终治疗结果更好.     

General Practitioner Appointment Systems, Patient Satisfaction, and use of Accident and Emergency Services--a Study in One Geographical Area

This study examines the relationship between (i) measures ofhow appointment systems work; (ii) patients' views of the arrangementsfor seeing their general practitioner; and (iii) practice self-referralrates to accident and emergency departments (A&E). Nineteengeneral practices and one district general hospital A&Edepartment in West Lothian, Scotland formed the setting fora prospective study employing analyses of computerized hospitalrecords, of patients surveys, and of data collected by practicesduring an 8-week study period in 1993. Principal outcome measureswere: (i) measures of appointment system operation correctedfor practice list size [number of unbooked (‘available’)appointments, appointment provision, proportion of patientsseen as ‘extras’]; (ii) patient views on practiceappointment systems (reported dissatisfaction with arrangementsfor being seen, proportion of patients reporting they normallywait in excess of 15 minutes when attending to be seen, theperceived availability of a doctor to deal with (a) urgent and(b) non urgent problems); (iii) practice self-referral ratesto local A&E department. Practices varied widely in theirrate of provision of appointments, in the proportion of appointmentswhich were unbooked at the start of the working day and in theproportion of patients identified as ‘extras’ byreception staff. These measures of appointment system operationcorrelated with patient dissatisfaction with the arrangementsof seeing a doctor in their practice and with the perceivedavailability of a doctor to deal with non urgent problems. Themeasures did not, however, correlate with A&E self-referralrates after they had been corrected for distance between practiceand hospital, or with the perceived availability of a doctorto deal with urgent problems. The proportion of patients seenas extras was related to the proportion of patients reportingthey normally waited in excess of 15 minutes to be seen whenattending their practice. Practices with small list sizes hadfewer respondents reporting dissatisfaction with the arrangementsfor seeing a doctor than had larger practices. Patients attendingA&E reported higher levels of dissatisfaction with the arrangementsfor seeing their general practitioner than did a sample of patientsattending their general practitioner. This finding persistedafter attempting to control for case mix, and was true whetherpatients were referred to A&E by their doctor or self-referred.The crow fly distance between a practice and the hospital isconfirmed as an important predictor of use of A&E servicesby patients who self-refer to such departments. This paper identifiesthree predictors of patient dissatisfaction with access arrangementsfor seeing a doctor. These are patients' perceptions of generalpractitioner availability to deal with non-urgent problems,practice list size, and measures of appointment system operation[the proportion of unbooked (‘available’) appointments,the rate of provision of appointments, and the proportion ofpatients identified as ‘extras’ by reception staff].Distance between practice and hospital is confirmed as an importantpredictor of a practice's self-referral rate to A&E. Thereis no evidence from this study that the variation amongst practicesin A&E serf-referral rates is related to the operation ofgeneral practitioner appointment systems.     

一药多名——现象、危害与整治

一药多名是近几年出现的“新生事物”，呈愈演愈烈之势，已经对我国医药卫生事业的健康发展造成相当不利的影响。本文旨在对这种现象加以分析，并提出解决问题的办法。