摘要:目的:探討有機磷農藥中毒患者阿托品使用方法,提高搶救成功率。方法: 對2005年6月至2009年6月我院收治的有機磷農藥中毒病人281例進行分組,所有患者均使用阿托品療法,A組為2007年以后132例序貫阿托品療法患者,B組2007年以前為常規使用靜推繼之肌注阿托品療法149例患者,根據有機磷農藥對膽堿酯酶復能劑的療效分為高效組和低效組,并結合病情嚴重程度共分為重度有機磷農藥中毒膽堿酯酶復能劑高效組、重度有機磷農藥中毒膽堿酯酶復能劑低效組,輕度有機磷農藥中毒膽堿酯酶復能劑高效組、輕度有機磷農藥中毒膽堿酯酶復能劑低效組4組,分別從達到阿托品化時間、維持阿托品化效果、反跳和中間綜合征發生率、開始撤藥平均時間、總住院費用、總住院平均時間、護士勞動強度進行總結和分析。結果: 維持阿托品化療效Ａ組與B組間有顯著差異,P值lt;0.01,開始撤藥平均時間、總住院平均時間、總住院費用、護士勞動強度Ａ組與B組間均有差異,P值lt;0.05,發生反跳和中間綜合征發生率、達到阿托品化時間在高效組間比較無差異,低效組間比較無差異,高效組與低效組比較有顯著差異,P值lt;0.01,主要與中毒藥物種類和病情嚴重程度有關,其次與阿托品治療方法有關。 結論: 序貫阿托品療法治療有機磷農藥中毒優于常規使用靜推繼之肌注阿托品療法。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 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.
A 49-year-old male patient with compartment syndrome of the right leg caused by acute carbon monoxide poisoning was admitted on December 30, 2019. The patient had a 10-year history of chronic nephritis and began dialysis treatment due to renal failure 1 month ago. Emergency surgical decompression for compartment syndrome was performed after admission. Two weeks later, the patient was diagnosed as the novel coronavirus pneumonia caused by 2019 novel coronavirus (2019-nCoV) infection. Then, the patient was transferred to the isolation ward, where he was given anti-infection, anti-virus, expectorant, heat-clearing and detoxifying drugs, bedside dialysis, and nutrition support symptomatic treatment. After 2 weeks of treatment, the patient is getting better, with no fever, cough, wheezing, and other discomfort. Meanwhile, the sensory and motor functions of right lower limb recovered gradually. This case is rare, severe, and difficult to diagnose and treat. It is the first reported case of novel coronavirus pneumonia after orthopedic surgery.
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 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.
On September 18th, 2023, the American Heart Association published clinical management guidelines for cardiac arrest and critical cardiac conditions caused by poisoning in the journal Circulation. Based on the differences in drug toxicity effects, our team has systematically interpreted the guidelines in three parts. This article, as the third part, focuses on interpreting the clinical management strategies for cardiac arrest caused by cyanide, organophosphates, carbamate and methemoglobinemia, and reviews the application of veno-arterial extracorporeal membrane oxygenation in poisoning treatment. Through in-depth analysis of the key recommendations in the guidelines, it aims to provide reference for clinical diagnosis and treatment.
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.
On September 18th, 2023, the American Heart Association published clinical management guidelines for patients with poisoning-induced cardiac arrest and critical cardiovascular illness in Circulation. Considering the important role of the guidelines in clinical practice, our team has divided them into three sections for detailed interpretation based on the different toxic effects of the drugs. This article is the second part of the interpretation, which combines the literature to interpret the recommendations related to cardiotoxic substance poisoning in the guidelines, mainly involving the clinical management of beta blockers, calcium channel blockers, digoxin and other cardiac glycosides, as well as sodium channel blocker poisoning, aiming to assist colleagues in their clinical practice through a detailed explanation of the key recommendations in the guidelines.
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.
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.