摘要
目的分析急性毒鼠强中毒(ATI)致呼吸衰竭的相关因素,研究中毒致呼吸衰竭及其并发症的治疗方案。方法将47例毒鼠强中毒患者诊断分级为接触反应、轻度中毒和重度中毒;将不同中毒程度患者血毒鼠强浓度进行对比,明确血液毒鼠强浓度与呼吸衰竭的关系;对发生呼吸衰竭患者给予肌松剂联合机械通气治疗,对重度中毒患者给予反复血液灌流(HP)治疗。结果呼吸衰竭发生情况:接触反应0/9;轻度中毒0/4;重度中毒患者中少儿组4/12(33.3%),成人组7/22(31.8%)。反复HP明显降低体内毒鼠强的蓄积量,疗效优于持续静脉静脉血液滤过或血液透析。肌松剂联合机械通气治疗可完全控制中毒症状并防治呼吸衰竭。结论ATI致呼吸衰竭的重要因素为体内毒鼠强的蓄积量以及全身抽搐的程度;对不同程度的中毒患者进行诊断分级并采取相应的治疗策略,具有较高的临床价值;反复HP是治疗中毒患者的最佳血液净化疗法;肌松剂联合呼吸机辅助通气可有效降低中毒患者的病死率。
Objective To find the correlative factors which induce breath failure in acute tetramine poisoning cases, and to work out a right treatment scheme for these cases. Methods 47 cases were clinically diagnosed as slight, middling and severe poisoning, separately. The tetramine concentration in blood was compared between the three groups to reveal the relationship between blood concentration of tetramine and breath failure. Patients with breath failure were treated with muscle relaxant plus mechanical ventilation. Repeated hemoperfusions were given to the severe poisoning patients. Results No breath failure occured in both slight and middling groups, while in severe poisoning group, breath failure happened in 33.3% (4/12) patients aged below 15, and in 31.8% (7/22) adult patients aged above 15. Repeated hemoperfusion declined the tetramine concentration in blood, and gave a better effect than with CVVH or CVVHD treatment. muscle relaxant plus mechanical ventilation may control the symptom of twitching completely, and prevent from breath failure effectively. Conclusion Breath failure in acute tetramine poisoning cases was induced by systemic twitching and high blood tetramine concentration. It is very important to grade the poisoning cases according to poisoning degree. Repeated hemoperfusion is the best for blood purification. muscle relaxant plus mechanical ventilation may reduce the mortality effectively.
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2005年第7期638-639,共2页
Medical Journal of Chinese People's Liberation Army
关键词
毒鼠强
中毒
呼吸功能不全
灌流
净化
tetramine
poisoning
respiratory insufficiency
perfusion
decontamination
