银环蛇咬伤致急性呼吸衰竭12例救治分析

目的：探讨银环蛇咬伤致急性呼吸衰竭的发病机理和治疗措施。方法：选择该类患者12例，应用抗蛇毒血清、机械通气等综合治疗。结果：经综合救治措施治疗，11例痊愈出院，1例死亡。结论：综合救治措施是抢救银环蛇咬伤致急性呼吸衰竭最有效的方法。     

机械通气及大黄在抢救毒蛇咬伤致呼吸衰竭的应用

目的探讨毒蛇咬伤致急性呼吸衰竭治疗措施。方法选择毒蛇咬伤致呼吸衰竭患者46例,治疗方法：①机械通气治疗：患者出现呼吸困难或者呼吸浅慢时,及时气管插管行机械通气。上机模式为辅助／控制通气或同步间歇指令通气,注意观察患者胸廓起伏情况及肺部体征,动态监测脉搏血氧饱和度、X线胸片及血气分析,并视病情变化调整通气参数,使其逐渐达到脱机标准;②生大黄20g＋清水250ml水煎15min,管饲,qd,连用3～5d;③常规治疗：伤口切开排毒及药物局部封闭,及早足量应用抗蛇毒血清等。结果患者住院时间6～20天,平均（13．4±5．2）d。通气时间〈48h者28例（60．9％）,48～72h者12例（26．1％）,〉72h者6例（13．0％）。治愈44例（95．7％）,死亡2例（4．3％）。死亡者均是就诊时合并多器官功能障碍者。结论机械通气联合大黄、抗蛇毒血清等集柬治疗是抢救毒蛇咬伤致呼吸衰竭有效的方法。     

109例毒蛇咬伤临床综合救治分析

目的：总结毒蛇咬伤的急诊处理方法,进一步提高毒蛇咬伤患者的抢救与治疗水平。方法：分析2009-2010年,我科收治的各类毒蛇咬伤患者109例的临床资料。结果：神经毒类毒蛇咬伤患者4例,血液毒类毒蛇咬伤患者5例,混合类毒蛇咬伤患者85例,不明毒蛇咬伤患者15例。经采用局部伤口常规处理,静滴并局部封闭注射抗蛇毒血清,重症患者及早进行CRRT防治MODS等方法治疗。痊愈105例（96.3%）,放弃治疗4例（3.7%）。结论：毒蛇咬伤应予早期伤口处理、应用抗蛇毒血清、抗感染、重症患者及早进行CRRT防治MODS,就诊时间的早晚、急救时的伤口处理是否及时得当与病情预后有密切关系。     

8例神经毒毒蛇咬伤的急救与护理

神经毒毒蛇咬伤人时,其致命的毒性为呼吸机麻痹致急性呼吸衰竭.我院2000年1月～2001年8月成功救治了8例神经毒毒蛇咬伤的患者,现将急救与护理介绍如下.     

8例神经毒毒蛇咬伤的急救与护理

神经毒毒蛇咬伤人时 ,其致命的毒性为呼吸机麻痹致急性呼吸衰竭。我院 2 0 0 0年 1月～ 2 0 0 1年 8月成功救治了8例神经毒毒蛇咬伤的患者 ,现将急救与护理介绍如下。1　临床资料1.1　一般资料　本组患者 8例 ,男 7例 ,女 1例 ,年龄 18～ 5 6岁。 8例均为上肢咬伤 ,其中严重中毒并发急性呼吸衰竭2例 ,所有伤者经积极抢救与护理获得痊愈。1.2　临床表现　毒蛇咬伤多发生于 4～ 10月间。蛇毒由多种不同的毒素组成 ,主要包括神经毒素、血循环素、混合素。神经毒主要表现为面部仅有麻木感、不红、不肿、不痛、不出血或少出血 ,伤后 1至 3小时出…     

毒蛇咬伤致自主呼吸停止的急救及护理

在我科救治的蛇伤病人中,常见的毒蛇咬伤致自主呼吸停止的蛇类有银环蛇及眼镜蛇.银环蛇蛇毒是一种神经毒,眼镜蛇蛇毒是一种既有神经毒也有循环毒的混合性毒素.这两种蛇毒所伤病人如抢救不及时,可因呼吸麻痹或呼吸循环衰竭而死亡.我科自1998年7月～2002年10月共收治蛇伤病人24例,其中4例出现自主呼吸停止,均及时对症救治,挽救了患者的生命.现将救护体会报告如下.     

毒蛇咬伤156例临床分析

目的:总结毒蛇咬伤的治疗方法,以提高对毒蛇咬伤的救治水平。方法:回顾性分析我科2012年4月-2013年3月间收治的156例毒蛇咬伤患者的临床资料,总结其综合治疗方法;按不同就诊时间段分成四组,比较各组间临床分型比例、住院天数及上呼吸机时间的差异。结果:156例患者中轻、重及危重型患者分别为83例、48例、25例,经伤口清创、应用抗蛇毒血清、重症患者及早行连续性血液净化(CBP)等综合治疗,痊愈149例(95.5%),放弃治疗7例(4.5%);就诊时间早、临床分型相对较轻者的住院天数及上呼吸机时间短。结论:毒蛇咬伤要尽早就诊,尽早使用抗蛇毒血清、重症患者尽早行CBP治疗,治疗时间与病情预后密切相关。     

蛇毒对人体凝血系统的影响

目的研究蛇毒活性成分对人体凝血系统的影响.方法本文采用日本CA-500全自动血凝分析仪测定蛇伤病人的凝血酶原时间(PT)及活化部分凝血活酶时间(APTT).结果血循毒和混合毒蛇咬伤病人的PT及APTT均延长:而神经毒毒蛇咬伤病人的PT及APTT正常.结论血循毒和混合毒毒蛇的蛇毒有明显的抗凝作用,神经毒毒蛇的蛇毒基本无抗凝作用.     

银环蛇咬伤急诊救治的临床研究

目的:探讨银环蛇咬伤致呼吸衰竭的急诊救治。方法:以1995年～2005年收治的银环蛇咬伤病人38例为研究对象,对病人急诊救治时间和是否获得正确救治与呼吸衰竭的关系进行探讨,以及对血液灌流的疗效进行分析。结果:本组38例中发生呼吸衰竭17例(45%),救治时间在6h内发生呼吸衰竭3例(8%),超过6h为14例(37%);正确救治组呼吸衰竭发生率14%(3/21)明显低于不正确救治组82%(14/17),差异有显著性意义(P<0.001);应用血液灌流治疗的病人使用呼吸机及住院平均时间均明显少于无使用此技术治疗的病人,差异有显著性意义(P<0.05)。结论:病人被银环蛇咬伤后急诊救治的时间越短,并经过正确地救治,其呼吸衰竭发生率就越小,即使发生呼吸衰竭时,其临床症状也轻。在正确救治的基础上使用血液灌流技术治疗的病人,其疗效明显优于无使用此技术治疗的病人。特别是被现在仍没有特异性抗蛇毒血清的毒蛇咬伤的病人建议应用此技术。     

毒蛇咬伤致自主呼吸停止的急救及护理

在我科救治的蛇伤病人中，常见的毒蛇咬伤致自主呼吸停止的蛇类有银环蛇及眼镜蛇。银环蛇蛇毒是一种神经毒，眼镜蛇蛇毒是一种既有神经毒也有循环毒的混合性毒素。这两种蛇毒所伤病人如抢救不及时，可因呼吸麻痹或呼吸循环衰竭而死亡。我科自1998年7月～2002年10月共收治蛇伤病人24例，其中4例出现自主呼吸停止，均及时对症救治，挽救了患者的生命。现将救护体会报告如下。     

Critical illness polyneuropathy: clinical findings and cell culture assay of neurotoxicity assessed by a prospective study

OBJECTIVE: First, to evaluate the role of typical intensive care-related conditions like sepsis, prolonged ventilation, drug effects and metabolic disorders in the pathogenesis of critical illness polyneuropathy (CIP); second, to investigate the possible significance of patient serum neurotoxicity assessed by an in vitro cytotoxicity assay with respect to CIP development. DESIGN: Prospective study. SETTING: Neurological intensive care unit. PATIENTS AND PARTICIPANTS: Twenty-eight patients who were on mechanical respiratory support for at least 4 days during a 21-month study period. RESULTS: Diagnosis of CIP was established by clinical and electrophysiological examination in 16 (57%) of 28 patients. Patients were investigated on days 4, 8 and 14 of mechanical ventilation. Two of 16 CIP patients had clinical signs of polyneuropathy at initial examination. Factors that correlated significantly with the development of CIP were: the multiple organ failure score on day 8 of ventilation, the total duration of respiratory support, the presence of weaning problems and the manifestation of complicating sepsis and/or lung failure. The in vitro toxicity assay showed serum neurotoxicity in 12 of 16 CIP patients. Electrophysiological investigations yielded false positive results of the toxicity assay in six patients (not developing CIP) and false negative results in four patients (developing clinical and electrophysiological signs of CIP). Statistical analysis did not reveal a significant correlation between the diagnosis of CIP and the finding serum neurotoxicity. CONCLUSION: The results support the hypothesis of a multi-factorial aetiopathogenesis of CIP. We observed serum neurotoxicity in the majority of CIP patients, indicating the possible involvement of a so far unknown, low-molecular-weight neurotoxic agent in CIP pathogenesis.     

Low dose of snake antivenom is as effective as high dose in patients with severe neurotoxic snake envenoming

The objective of this study was to evaluate the effects of two different dosage protocols on the outcome of patients with severe neurotoxic snake envenoming, using a retrospective analysis of patients admitted with a diagnosis of severe neurotoxic snake bite over a 4 year period. In the study, 55 snake bite victims requiring ventilatory support for severe neurotoxic envenoming received either 150 ml of polyvalent snake antivenom (SAV) (low dose SAV group, n = 28) or 100 ml of SAV at presentation followed by 100 ml every 6 hours until recovery of neurological manifestations (high dose group, n = 27). The median dose of SAV in the high dose group was 600 ml (range 300 to 1600). The duration of mechanical ventilation in the low dose group (median 47.5 hours; range 14 to 248) was similar to that in the high dose group (median 44 hours; range 6 to 400). The mean (SD) duration of intensive care unit stay was similar in the two groups. There were three deaths in the high dose group; two patients in the low dose group had neurological sequelae. All other patients improved, had no residual neurological deficit, and were discharged. We conclude that there is no difference between a protocol using lower doses of SAV and one with higher doses in the management of patients with severe neurotoxic snake envenoming.     

机械通气中呼吸拮抗时药物治疗对血流动力学及呼吸功能的影响

目的研究机械通气中呼吸拮抗时应用咪唑安定和潘可罗宁对血流动力学及呼吸功能的影响。方法将30例机械通气中发生呼吸拮抗的患者随机分成3组,组1使用潘可罗宁,组2联合使用咪唑安定和潘可罗宁,组3使用咪唑安定。分别观察3组用药前及用药后5、15、30和60min时人机协调情况,并监测血压、心率、呼吸频率及脉搏血氧饱和度(SpO2)的动态变化。结果3组患者用药前均存在人机对抗,自主呼吸频率快SpO2下降。组2患者用药后呼吸改善最明显,人机协调一致率高,用药30min内达100%,且持续时间长;血压、心率变化小,呼吸改善及低氧血症纠正好。组1用药后5min人机协调一致率即达100%,但持续时间短;血压和心率显著升高,自主呼吸频率及低氧血症有所改善。组3人机协调一致率最低;血压、心率、呼吸频率及低氧血症均无明显变化。结论咪唑安定和潘可罗宁合用能保持循环功能稳定,维持合适的通气功能,是一种能够合理改善机械通气中呼吸拮抗的药物治疗方法。     

Bites by the king cobra (Ophiophagus hannah) in Myanmar: successful treatment of severe neurotoxic envenoming.

Three patients bitten by the world's largest species of venomous snake, the king cobra (Ophiophagus hannah), were observed in Myanmar (Burma). All three were involved in the famous snake dance in Yangon (Rangoon) Zoological Gardens. One patient showed no signs of envenoming despite a sustained bite, another developed only signs of local envenoming, but in a third there was severe neurotoxic envenoming requiring mechanical ventilation for 64 1/2 hours, episodes of hypotension and massive swelling of the bitten limb. This patient showed some signs of recovery before delayed treatment with specific antivenom. It is possible that all three patients had some immunity to king cobra venom resulting from traditional 'immunization' achieved by scratching venom into the skin. The literature on king cobra bites is reviewed and recommendations given for antivenom and ancillary treatments.     

纤维支气管镜肺泡灌洗对重症呼吸机相关性肺炎患者血清炎症因子水平的影响

目的探讨纤维支气管镜肺泡灌洗对重症呼吸机相关性肺炎(VAP)患者血清炎症因子水平的影响。方法将68例重症VAP患者依据随机数字表法分为对照组和观察组,每组各34例。对照组采取常规肺泡灌洗联合吸痰治疗,观察组则采取纤维支气管镜肺泡灌洗联合吸痰治疗,比较两组肺部感染控制时间、机械通气治疗时间、体温恢复至正常时间、肺部感染评分(CPIS)、白细胞计数、呼吸功能、血气指标及血清炎症因子水平变化。结果观察组治疗后肺部感染控制时间、机械通气治疗时间、体温恢复至正常时间、肺部感染评分(CPIS)、白细胞计数、呼吸功能、血气指标及血清炎症因子水平均明显优于对照组(P0.05)。结论纤维支气管镜肺泡灌洗可明显改善重症VAP患者呼吸功和血气指标,降低血清炎症因子水平。     

压力支持通气模式下呼气触发灵敏度对呼吸力学指标的影响祆

目的研究压力支持通气(PSV)模式下呼气触发灵敏度(ETS)对慢性阻塞性肺疾病(COPD)患者呼吸力学指标的影响,揭示ETS对通气效果的影响。方法选取2006年12月至2008年1月收入我院呼吸内科重症监护室的COPD急性加重期合并呼吸衰竭行有创机械通气患者31例,行气管插管或气管切开接伽利略金型呼吸机。病情稳定后采用PSV模式,在其他参数不变的情况下随机调整ETS%水平于5%、35%、65%,通气30~60分钟后测量呼吸力学参数及血液动力学参数。应用自身对照的方法对不同ETS%水平下呼吸力学等参数进行比较。结果随着ETS%水平增加,潮气量、吸气时间、吸呼比、呼气流速减少或下降(P<0.01),不同ETS%水平的潮气量分别为(553.20±89.90)ml、(499.18±63.68)ml、(450.40±59.99)ml(P<0.01),吸气时间分别为(1.18±0.34)s(、0.88±0.21)s(、0.65±0.12)s(P<0.01),吸呼比分别为0.55±0.13、0.45±0.09、0.33±0.06(P<0.01),呼气流速分别为(52.49±7.95)L/min(、39.64±6.85)L/...     

机械通气救治急性中毒致呼吸衰竭28例临床分析

目的：探讨机械通气治疗急性中毒所致呼吸衰竭的疗效。方法：回顾性分析28例急性中毒所致的呼吸衰竭患者机械通气的临床资料。结果：治愈25例,死亡3例。上机时间10h-9d,平均49．6h。与机械通气相关的并发症有肺部感染21例,低血压3例。结论：机械通气是治疗急性中毒所致呼吸衰竭的有效方法。     

盐酸戊乙奎醚与阿托品联合应用治疗急性重度有机磷中毒合并呼吸衰竭的临床研究

目的 观察盐酸戊乙奎醚(长托宁)和阿托品联合应用抢救急性重度有机磷中毒(ASOPP)合并呼吸衰竭(RF)的效果.方法 回顾性分析我院急诊科2006年1月至2009年12月收治的ASOPP合并RF患者56例(均行气管插管,呼吸机辅助/控制呼吸),其中阿托品联合长托宁治疗组(Ⅰ组)31例,阿托品治疗组(Ⅱ组)25例,比较两组患者的住院时间、拔管脱机时间、胆碱酯酶恢复时间、并发症发生率、治愈率、病死率.结果 阿托品联合长托宁治疗组和阿托品治疗组患者的住院时间分别为(5.O土1.5)天和(18.0±3.O)天(P＜O.01),拔管脱机时间分别为(3.5土1.2)天和(7.O士2.5)天(P＜O.01),胆碱酯酶恢复时间分别为(3.O±1.2)天和(13.3±3.5)天(P＜O.01);并发症发生率分别为6.5%和44.O%(P＜O.01),治愈率分别为96.8%和80.O%(P＜O.05),病死率分别为3.2%和20.O%(P＜O.05).结论 长托宁与阿托品联合应用治疗ASOPP合并RF,疗效优于阿托品单独治疗.     

Risk factors for the development of hemodynamically significant cardiac arrhythmias in patients with mechanical ventilation

PURPOSE: The purpose of this article was to identify the risk factors related to development of hemodynamically significant cardiac arrhythmias in patients with mechanical ventilation. MATERIALS AND METHODS: Holter recording and echocardiogram were performed within 24 hours of ventilator initiation in patients on mechanical ventilation (MV) owing to respiratory failure (RF) from various reasons. RESULTS: From 68 patients, hemodynamically significant cardiac arrhythmias were detected in 18 patients (26.5%). Initial mean arterial pressure, maximal heart rate, and initial pH were identified as risk factors for hemodynamically significant cardiac arrhythmias. Additionally, the patients with pressure-controlled ventilation as an initial ventilatory mode developed hemodynamically significant cardiac arrhythmias less frequently than the patients with other modes (15.8% vs. 40%, P = .03). In multivariate analysis, initial mean arterial pressure (< 70 mm Hg, odds ratio [OR]: 5.5; 95% confidence interval [CI]: 1.2 to 24.2, P = .026), maximal heart rate (> 120/min, OR: 19.7; 95% CI: 2.0 to 190.9, P = .01), and pressure-controlled ventilation (OR: 0.13; 95% CI: 0.03 to 0.55, P = .006) were associated with the development of hemodynamically significant cardiac arrhythmias. CONCLUSIONS: These findings suggest that during the early stages of mechanical ventilation with acute respiratory failure, hemodynamically significant cardiac arrhythmias are directly associated with tachycardia (> or = 120/min), initial MAP (<70 mm Hg), and, inversely, the initial use of pressure-controlled ventilation.     

序贯性机械通气治疗AECOPD急性呼吸衰竭的观察与护理

目的探讨序贯性机械通气治疗慢性阻塞肺疾病加重期(AECOPD)急性呼吸衰竭的护理要点。方法对29例AECOPD并发急性呼吸衰竭实施序贯性机械通气治疗与护理干预。结果 29例患者中,24例好转出院,5例无效。结论序贯性机械通气治疗AECOPD并发呼吸衰竭,必须进行严密细致的病情观察、严格有效的呼吸道管理、认真评估病情,准确无误判断肺部感染控制窗及精心周到的心理护理。