摘要:目的:探讨有机磷农药中毒患者阿托品使用方法,提高抢救成功率。方法: 对2005年6月至2009年6月我院收治的有机磷农药中毒病人281例进行分组,所有患者均使用阿托品疗法,A组为2007年以后132例序贯阿托品疗法患者,B组2007年以前为常规使用静推继之肌注阿托品疗法149例患者,根据有机磷农药对胆碱酯酶复能剂的疗效分为高效组和低效组,并结合病情严重程度共分为重度有机磷农药中毒胆碱酯酶复能剂高效组、重度有机磷农药中毒胆碱酯酶复能剂低效组,轻度有机磷农药中毒胆碱酯酶复能剂高效组、轻度有机磷农药中毒胆碱酯酶复能剂低效组4组,分别从达到阿托品化时间、维持阿托品化效果、反跳和中间综合征发生率、开始撤药平均时间、总住院费用、总住院平均时间、护士劳动强度进行总结和分析。结果: 维持阿托品化疗效Ａ组与B组间有显著差异,P值lt;0.01,开始撤药平均时间、总住院平均时间、总住院费用、护士劳动强度Ａ组与B组间均有差异,P值lt;0.05,发生反跳和中间综合征发生率、达到阿托品化时间在高效组间比较无差异,低效组间比较无差异,高效组与低效组比较有显著差异,P值lt;0.01,主要与中毒药物种类和病情严重程度有关,其次与阿托品治疗方法有关。 结论: 序贯阿托品疗法治疗有机磷农药中毒优于常规使用静推继之肌注阿托品疗法。Abstract: Objective: To discussion of atropine in organophosphorus pesticide poisoning patients with the use of two different methods to improve the success rate. Methods: For June 2005 to June 2009 inour hospital a total of organophosphorus pesticide poisoning 281 cases were divided into A group and B group, All patients were using atropine therapy, 132 cases of sequential therapy in patients with atropine is divided into A group, 149 cases of routine use of intravenous injection and intramuscular injection of atropine group patients were divided into B group, From the following aspects were analyzed and summarized, They are the maintenance of the effect of atropinization, the average time for the beginning of withdrawal, the total hospitalization costs, the total average time for hospitalization and nurses labor intensity. According to the organic phosphorus pesticide on the efficacy of cholinesterase agents are divided into efficient and inefficient groups groups, From the types of poisons, toxic ways, poisoning performance and Complications for stratified, They were divided into 4 groups, severe organophosphorus pesticide poisoning and cholinesterase reactivator can be highly effective group, severe organophosphorus pesticide poisoning and cholinesterase reactivator Lowefficacy group, mild organophosphorus pesticide poisoning and cholinesterase reactivator can be highly effective group, mild organophosphorus pesticide poisoning and cholinesterase reactivator Lowefficacy group, Correlation analysis Antijumping and the incidence of intermediate syndrome and atropinization time.Results:Maintain the efficacy of atropine of A group and B were significantly different between groups, Plt;0.01, the average time began to withdraw drugs, the total average time for hospitalization, total hospital charges, nursing labor intensity of A group and B are differences between the two groups, P＜0.05. Rebound occurs and the incidence of intermediate syndrome, to atropinization time high between the two groups showed no difference between the two groups showed no differences between inefficient and efficient group and inefficient group were significantly different, Plt;0.01, mainly related to poisoning by drug type and severity of illness, followed with atropine therapy. Conclusion:Atropine sequential therapy is superior to organophosphorus pesticide poisoning by conventional atropine treatmen.
ObjectiveTo explore the effects of small dose and low pressure lavage on gastrointestinal hemorrhage induced by acute poisoning. MethodsWe collected the clinical data of all the patients diagnosed as gastrointestinal hemorrhage induced by acute poisoning treated between January 2011 and December 2012. The patients were divided into two groups: control group and treatment group, according to the different treatments they underwent. The control group received traditional treatment only, while the treatment group received small dose and low pressure lavage as well as the traditional treatment. After recording the ages, poisoning dose, pretreatment time, shock and complications, we evaluated the risk of death by calculating ROCKALL scores. ResultsThe differences of ages, sexes, and poisoning dose between these two groups were not significant. However, the death rate in high and middle risk patients of the treatment group was significantly lower than that of the control group (P<0.05). ConclusionThe small dose and low pressure lavage can improve the prognosis of the gastrointestinal hemorrhage induced by acute intoxication.
Acute carbon monoxide poisoning is a common and frequently occurring disease in winter and spring in China, with high disability and mortality. Delayed encephalopathy is a serious sequela after the pseudo-convalescence. Its mechanism is complex, including environmental and genetic factors, hypoxia and energy metabolism disorder, cytotoxicity and oxygen free radical damage, immune disorder and inflammatory activation, neurotransmitter disorder, brain parenchymal changes, vascular and hemorheological abnormalities, calcium overload, and cell apoptosis. At present, methods for predicting delayed encephalopathy in acute carbon monoxide poisoning include detailed inquiry of medical history, laboratory examination of relevant indicators, electrophysiological examination, brain imaging examination, and evaluation scale prediction. This review summarizes the research status of the pathogenesis and early prediction methods of delayed encephalopathy in acute carbon monoxide poisoning, with a view to providing reference for future research directions.
ObjectiveTo systematically evaluate the effect of hyperbaric oxygen therapy on delayed encephalopathy caused by carbon monoxide poisoning.MethodsChina National Knowledge Infrastructure, Wanfang Data, CQVIP data, China Biology Medicine Database, PubMed, Embase, and Cochrance Library were searched by computer for randomized controlled trials on hyperbaric oxygenation for delayed encephalopathy caused by carbon monoxide poisoning which were published in English or Chinese from the dates of establishment of the databases to March 31st, 2019. After literature including, excluding, and screening, RevMan 5.2 software was used to conduct a meta-analysis.ResultsA total of 25 studies were included, including 1 797 patients, 924 in the hyperbaric oxygen therapy group (the trial group) and 873 in the control group. The clinical effective rate [relative risk (RR)=1.24, 95% confidence interval (CI) (1.19, 1.30), P<0.000 01], the normal rate of electroencephalogram [RR=2.10, 95%CI (1.18, 3.75), P=0.01], the Mini-Mental State Examination score [standard mean difference (SMD)= 3.19, 95%CI (2.06, 4.32), P<0.000 01], and the Activities of Daily Living score [SMD=1.46, 95%CI (1.02, 1.90), P<0.000 01] were all higher in the trial group than those in the control group.ConclusionHyperbaric oxygen therapy for delayed encephalopathy caused by carbon monoxide poisoning can improve symptoms.
Objective To explore the risk factors of nosocomial pulmonary infection in acute pesticide poisoning. Methods The clinical data of patients with acute pesticide poisoning hospitalized in the Emergency Department of the First Affiliated Hospital of Wannan Medical College and the Second Affiliated Hospital of Wannan Medical College between January 1, 2021 and September 30, 2023 were retrospectively analyzed. Patients were divided into pulmonary infection group and non-pulmonary infection group according to whether they had pulmonary infection during hospital. Multiple logistic regression was used to analyze the independent risk factors of nosocomial pulmonary infection in patients with acute pesticide poisoning, and a risk prediction model (nomogram) was constructed. The predictive efficacy of nomogram and independent predictors in nosocomial pulmonary infection were analyzed by using the receiver operating characteristic curve. Calibration curve and decision curve were used to evaluate the differentiation and clinical application value of the model. Results A total of 189 patients with acute pesticide poisoning were included in the study, with an average age of (58.12±18.45) years old, 98 males (51.85%) and 91 females (48.15%). There were 36 cases (19.05%) of pulmonary infection. Multiple logistic regression analysis showed that age [odds ratio (OR)=1.030, 95% confidence interval (CI) (1.001, 1.060), P=0.040], type 2 diabetes mellitus [OR=2.770, 95%CI (1.038, 7.393), P=0.042], ischemic cerebrovascular disease [OR=3.213, 95%CI (1.101, 9.376), P=0.033], white blood cell count [OR=1.080, 95%CI (1.013, 1.152), P=0.019], activities of daily living score [OR=0.981, 95%CI (0.965, 0.998), P=0.024] were independent predicting factors for nosocomial pulmonary infection in acute pesticide poisoning. The area under the curve of nosocomial pulmonary infection in patients with acute pesticide poisoning predicted by nomogram based on the above factors was 0.813 (P<0.001). The calibration curve showed that the prediction probability was consistent with the actual occurrence probability (P=0.912), and the decision curve showed that the nomogram had good clinical application value. Conclusions Age, activities of daily living score, type 2 diabetes mellitus, ischemic cerebrovascular disease, and white blood cell count are independent predictors of nosocomial pulmonary infection in acute pesticide poisoning. The nomogram constructed based on them has good differentiation and consistency, which can provide basis for early identification and intervention of clinical staff.
Poisoning is a frequent reason for patients to seek emergency medical attention, and in severe cases, it can result in severe cardiac disease or cardiac arrest. American Heart Association published the guideline for the management of patients with cardiac arrest or life-threatening toxicity due to poisoning in Circulation on September 18, 2023. Based on the literature, this article interprets the suggestions related to neurotoxic substances in this guideline, mainly involving the clinical management of benzodiazepines, opioids, cocaine, local anesthetics, and sympathomimetic substances poisoning. By interpreting the recommended points of the guide in detail, it is hoped that it will be helpful for the diagnosis and treatment of readers.
Objective To construct a nomogram model for predicting delayed encephalopathy after acute carbon monoxide poisoning (DEACMP) in emergency departments. Methods All patients with acute carbon monoxide poisoning who visited the Department of Emergency of Zigong Fourth People’s Hospital between June 1st, 2011 and May 31st, 2023 were retrospectively enrolled and randomly divided into a training set and a testing set in a 6∶4 ratio. LASSO regression was used to screen variables in the training set to establish a nomogram model for predicting DEACMP. The discrimination, calibration, and clinical practicality were compared between the nomogram and Glasgow Coma Scale (GCS) in the training and testing sets. Results A total of 475 patients with acute carbon monoxide poisoning were included, of whom 41 patients had DEACMP. Age, GCS and aspartate aminotransferase were selected as risk factors through LASSO regression, and a nomogram model was constructed based on these factors. The areas under the receiver operating characteristic curves for nomogram and GCS to predict DEACMP in the training set were 0.897 [95% confidence interval (CI) (0.829, 0.966)] and 0.877 [95%CI (0.797, 0.957)], respectively; and those for nomogram and GCS to predict DEACMP in the testing set were 0.925 [95%CI (0.865, 0.985)] and 0.858 [95%CI (0.752, 0.965)], respectively. Compared with GCS, the performance of nomogram in the training set (net reclassification index=0.495, P=0.014; integrated discrimination improvement=0.070, P=0.011) and testing set (net reclassification index=0.721, P=0.004; integrated discrimination improvement=0.138, P=0.009) were both positively improved. The calibration of nomogram in the training set and testing set was higher than that of GCS. The decision curves in the training set and testing set showed that the nomogram had better clinical net benefits than GCS. Conclusion The age, GCS and aspartate aminotransferase are risk factors for DEACMP, and the nomogram model established based on these factors has better discrimination, calibration, and clinical practicality compared to GCS.
Acute poisoning is characterized by a sudden and rapid onset, most poisons lack specific antidotes. Even with the full use of blood purification, mechanical ventilation, and various drugs, it is often difficult to change the fatal outcome of critically ill patients. In recent years, extracorporeal membrane oxygenation (ECMO) has gradually gained attention and exploratory application in the treatment of acute poisoning due to its significant cardiopulmonary function support, veno-venous ECMO is used for severe lung injury after poisoning, acute respiratory distress syndrome and respiratory failure due to ineffective mechanical ventilation, and it can also be used to assist the removal of residual poisons in the lungs. Veno-arterial ECMO is commonly employed in patients with circulatory failure following poisoning, fatal cardiac arrhythmias, and arrest of cardiac and respiratory. The application of veno-arterio-venous ECMO has also been reported. The mode of ECMO necessitates timely adjustments according to the evolving illness, while ongoing exploration of additional clinical indications is underway. This review analyzes and evaluates the application scope and effectiveness of ECMO in acute poisoning in recent years, with a view to better exploring and rationalizing the use of this technology.
ObjectiveTo explore the differential diagnosis value of subpleural bandlike ground-glass opacity (GGO) in thoracic CT in paraquat poisoning pneumonia. MethodsA retrospective study was carried out by retrieving the patients CT database from March 2013 to March 2015. The patients with paraquat poisoning pneumonia, interstitial pneumonia and pulmonary alveolar proteinosis (PAP) were recruited and their radiological characteristics of thoracic CT were analyzed. ResultsA total of 698 newly diagnosed interstitial pneumonia patients were finally enrolled in this study, 392 of them (56.2%) presented with GGO in thoracic CT. A total of 38 newly diagnosed PAP patients and 14 paraquat poisoning patients were enrolled, and GGO presented in thoracic CT of 100.0% and 42.9% of them respectively. Subpleural bandlike GGO was mostly commonly found in 83.3% of the paraquat poisoning pneumonia patients with GGO in thoracic CT, followed by 18.4% of the PAP patiens and 5.6% of the interstitial pneumonia patients with GGO in thoracic CT, which were significantly lower than that in the paraquat poisoning pneumonia patients (P < 05). GGO associated crazy paving pattern in thoracic CT was mostly commonly found in 94.7% of the PAP patients, followed by 0.5% of the interstitial pneumonia patients and none of the paraquat poisoning pneumonia patients. All the PAP patients with subpleural bandlike GGO were found associated with crazy paving pattern, while none of such association was found in the interstitial pneumonia or the paraquat poisoning pnuemonia patients. GGO coexisting with honeycombing and subpleural line were respectively found in 22.7% and 11.2% of the interstitial pneumonia patients, and none of such association was found in the PAP or the paraquat poisoning pneumonia patients. ConclusionsSubpleural bandlike GGO is mostly commonly found in paraquat poisoning pneumonia patients and rarely in PAP and interstitial pneumonia patients. Combined with crazy paving pattern and subpleural line, subpleural bandlike GGO may be a valuable feature in the diagnosis of paraquat poisoning pneumonia patients.
ObjectiveTo investigate the effects of leptin on the oxidative damage in human retinal pigment epithelial (RPE) cells. MethodsHuman RPE cells (ARPE-19) were cultured in vitro, and randomly divided into control group and insulin resistance group. RPE cells were treated with 0, 10, 100 ng/mL leptin for 24, 48, 72 hours respectively. Then the levels of reactive oxygen species (ROS) expression in RPE cells were detected by 2', 7'-dichlorofluorescin-diacetate (DCFH-DA), and the levels of 8-hydroxy-2'-deoxyguanosine (8-OHdG) expression in RPE cells were observed by immunocytochemistry (ICC), and the levels of human 8-oxoguanine DNA glycosylase l (hOGG1) expression in lysate were measured by Western blot. ResultsAfter 24, 48, 72 hours, the level of ROS (Control group:F=37.136, 37.178, 49.634; P < 0.05. Insulin resistance group:F=9.822, 28.881, 71.150;P < 0.05), 8-OHdG (Control group:F=88.643, 390.920, 1039.276;P < 0.05.Insulin resistance group:F=273.311, 299.155, 82.237;P < 0.05) and hOGGl (Control group:F=470.062, 1073.113, 295.456;P < 0.05. Insulin resistance group:F=240.032, 592.389, 527.760;P < 0.05) expression increased significantly with the increase of leptin concentration in control group and insulin resistance group. Under the same leptin concentration, the level of 8-OHdG has a trend that it was higher in the insulin resistance group than the control group. After 24 hours, the difference of hOGGl expression between control group and insulin resistance group was not significant (F=23.392, P > 0.05). After 72 hours, the level of hOGGl expression was significantly higher in the insulin resistance group than the control group (F=129.394, P < 0.05). The level of hOGGl expression was significantly higher at 48 hours than that at 24 hours and 72 hours (P < 0.05). ConclusionLeptin could induce the oxidative damage of RPE cells in normal and insulin resistance status. With the increase of leptin concentration and time extended, the degree of oxidative damage and its repair were both increased. The degree of oxidative repair increased with the increase of leptin concentration, but decreased with time extended.