急救有机磷农药中毒阿托品化的观察及护理

阿托品为临床上抢救有机磷农药中毒的首选药物.而正确使用阿托品,使其剂量达到最佳治疗效果,即“阿托品化”,是抢救中毒病人成功的关键.现将本院1990～1994年对口服有机磷农药急性中毒患者42例,在抢救中使用阿托品化的临床观察及护理总结如下:     

长托宁救治有机磷急性中毒性肺水肿疗效分析

目的 观察长托宁抢救有机磷急性中毒性肺水肿的临床疗效。方法 在常规应用胆碱脂酶复能剂解磷定及其他对症治疗的基础上应用长托宁治疗，对效果进行分析。结果 20例有机磷急性中毒性肺水肿患者痊愈18例，总有效率90％。结论 长托宁可取代阿托品抢救有机磷中毒，且副作用小，给药次数少，减少医务人员的工作量及病员的经济负担，简单易行，安全可靠。     

阿托品持续用药新方案

阿托品持续用药新方案赵宗慎阿托品是抢救有机磷中毒的首选药物。早期、足量、反复、持续、快速达到阿托品化是抢救有机磷中毒公认的用药原则。但是，我们在多年的临床实践中发现，该用药方案中关于达到阿托品化后持续用药的规定，对于经呼吸道和皮肤吸收中毒的病人较为合...     

急性有机磷中毒的抢救与护理

急性有机磷农药中毒是临床上常见急症之一，在基层医院收治率较高，患者症状凶险，重度患者早期即出现呼吸循环衰竭，如抢救护理不当，常可出现严重后果，故彻底洗胃、保持呼吸道通畅、早期基本生命支持、合理应用阿托品及胆碱酯酶复能剂，是抢救成功的关键。病情转归后的心理护理和临床指导是患者顺利恢复的重要保证。     

救治有机磷中毒时防止阿托品中毒应注意的问题

急性有机磷农药中毒(AOIP)的治疗除使用胆碱酯酶复能剂和彻底洗消外,阿托品化[1]是治疗AOIP的有效手段,但若不能正确识别阿托品化,滥用阿托品,则必然导致阿托品中毒。据报道,AOIP的患者死于阿托品中毒分别为20.8%[2]、18.8%[3]、22.2%[4]。因此,如何正确识别阿托品化具有重要意义。1　影响认识阿托品化的因素1.1　瞳孔反应　(1)眼局部染毒后,由于有机磷毒物透过角膜,使虹膜胆碱酯酶受抑制,可致瞳孔明显的、持久的缩小,或一大一小,此时给予阿托品,扩瞳效应很差,常误认为阿托品用量不足,甚至还会误为脑水肿并发脑疝等,所以,当患者瞳孔变…     

阿托品化与阿托品中毒的临床观察

阿托品为临床上抢救有机磷中毒及休克之常用药物，而正确地估计阿托品的疗效，又是抢救成功的一个关健。在治疗过程中，阿托品中毒，又往往是造成患者死亡及增加严重后遗症的一大原因。因此，对于阿托品化及阿托品中毒的观察，是与抢救成功率的高低有着密切的联系。     

早期换血救治重度有机磷中毒1例体会

小儿重度有机磷中毒 ,按常规救治 ,清除毒物 ,应用阿托品及胆碱酯酶复能剂 ,在临床上仍存在着一定的问题 ,尤其是重度口服中毒者 ,抢救成活率低 ,死亡率仍在 6 0 %以上[1] 。我科采用早期置换新鲜全血[1,2 ] ,使体内胆碱酯酶活性迅速提高 ,成功地救治 1例重度有机磷中毒患儿 ,报告如下。1　临床资料患者 ,男 ,1岁 8个月 ,患儿于入院前 2 0ｍｉｎ误服敌敌畏乳油剂 30ｍｌ,出现神志不清、呼吸不整等。查体 :营养发育一般 ,神志不清 ,呈昏迷状态 ,口唇末梢发绀 ,呼吸浅表不规则 ,口鼻腔溢出大量白色泡沫 ,患儿呈窒息状态 ,皮肤多汗、潮湿 ,双瞳…     

血液灌流抢救急性重症有机磷农药中毒的临床研究

目的观察血液灌流抢救急性重症有机磷农药中毒的疗效。方法对49例重症有机磷农药中毒患者,随机分为灌流组25例,非灌流组24例,灌流组在常规洗胃、阿托品、碘解磷定、复能剂和脱水等治疗的基础上,采用血液灌流治疗,并对其结果进行分析。结果血液灌流组治愈23例,治愈率92.0%,非灌流组治愈16例,治愈率66.7%,两组治愈率相比有显著性差异(P<0.05)。灌流组减少了阿托品用量,缩短了昏迷清醒时间、胆碱酯酶恢复及机械通气时间,缩短了平均住院日,与非灌流组相比,两组有显著差异(P<0.05)。结论血液灌流是救治重度有机磷农药中毒的有效方法。     

急性有机磷中毒60例的急救护理

目的探讨急性有机磷农药中毒的急救与护理,及应用解毒剂、复能剂与积极的护理措施是否可提高治愈率。方法回顾性分析60例急性有机磷农药中毒的临床资料。结果60例患者中轻、中度中毒者全部治愈,重度中毒患者死亡3例,抢救成功率95％。结论对急性有机磷农药中毒患者进行争分夺秒的抢救与细心护理至关重要,可明显提高治愈率。     

持续静注东莨菪碱抢救有机磷中毒58例

我院自1990年1月～1995年12月，改革了传统的定时定量静注阿托品的用药方法，采用持续静注东莨菪碱至莨菪化的方法，成功抢救有机磷中毒58例，并摸索出莨菪化的可靠指征和莨菪化过程中的一些规律，为评价疗效，现与同期用阿托品抢救的52例对照比较，报告如下。1对象和方法1．1病例选择均为住院患者，诊断明确，随机选择病例分组。东莨菪碱组58例，男25例，女33例，年龄1～60岁；口服中毒57例，接触中毒1例；轻度中毒23例，中度24例，重度11例。阿托品组52例，男18例，女34例，年龄3～58岁，均为口服中毒；轻度中毒22例，中度21例，重度9例。…     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.