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Effects of Improved Gastric Lavage for Patients of Acute Poisoning

目的　探討改良洗胃法在急性中毒患者洗胃中的應用效果。 方法　將2010年1月－2012年2月收治的口服藥物中毒需采用電動洗胃機洗胃的患者分為觀察組和對照組，觀察組采用改良洗胃法，對照組采用傳統的洗胃方法，比較兩組患者洗胃總時間、洗胃總液量、一次性插管成功率、堵管發生率及并發癥發生率。 結果　觀察組患者洗胃總時間低于對照組[（28.60 ± 6.32）、（34.51 ± 5.37）min]，洗胃總液量低于對照組[（10 856 ± 3 818）、（17 962 ± 3 855）mL]，差異有統計學意義（P＜0.001）；一次性插管成功率高于對照組（93.02% 、67.44%），差異有統計學意義（P=0.03）；堵管發生率為低于對照組（4.88%、27.91%），差異有統計學意義（P=0.03）；并發癥發生率低于對照組（2.33%、37.21%），差異有統計學意義（P＜0.001）。 結論　改良洗胃法可減少洗胃總時間及洗胃液總量，提高一次性插管的成功率，同時可降低堵管及并發癥的發生率。

Evaluation on the Effect of Improved Oven for Defluorination in China

Objectives　To analyze the effect of improved oven for defluorination in coal-burning endemic fluorosis areas in China, and to provide evidence for the prevention and control of fluorosis. Methods　Electronic databases including CNKI, CBM, VIP and CDMD-D (1989 to 2005), were searched. We also checked the reference lists of relevant articles. We selected relevant articles according to the predefined inclusion and exclusion criteria. The methodological quality was assessed . Data on room heat preservation and the effect of improved oven for defluorination were collected in the surveillance spots of Three Gorges Reservoir. Correlation analyses were conducted between the improved oven and its effect parameters. Results　Twelve articles of low quality met the selection criteria, of which 9 were graded C and 3 were graded D in terms of the methodological quality. A negative correlation was found between the decreasing rate of normal oven use and the decreasing rate of dental fluorosis as well as of urine fluorine (Pearson correlation coefficient r = – 0.87, – 0.63, Plt;0.01, lt;0.05, respectively). Analysis also revealed a positive correlation between room heat preservation and the decreasing rate of dental fluorosis as well as of normal oven use (the two Spearman correlation coefficients and P values were the same: r = –1.00, Plt;0.01). Conclusion　High-quality studies on the effect of improved oven for defluorination in China are not available. Based on the current evidence, the improved oven for defluorination and the correct use, maintenance and house rebuilding for heat preservation may help to prevent fluorosis.

tropine Sequential Therapy and Conventional Atropine Treatment of Organophosphorus Pesticide Poisoning in the Efficacy Analysis

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 Lowefficacy group, mild organophosphorus pesticide poisoning and cholinesterase reactivator can be highly effective group, mild organophosphorus pesticide poisoning and cholinesterase reactivator Lowefficacy group, Correlation analysis Antijumping 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, Plt;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, Plt;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.

An Experience of Cure of A Cluster of Acute Subprosttrate Sophora Root Toxication (Reports of 56 Cases)

目的:總結群體性急治療提供了可供借鑒的經驗。性山豆根中毒的臨床救治經驗。方法:回顧性分析我院收治的56例群體性急性山豆根中毒的患者臨床資料。所有患者均進行了補液、利尿治療,有肝功能損害者行保肝治療,有心臟損害者與營養心肌治療。結果:56例中,以頭昏(47例,占83.93%)和胃腸道癥狀為主,表現為惡心54例(96.43%),嘔吐43例(76.79%),腹痛47例(83.93%)和腹瀉21例(37.5%)。部分患者出現心肌損害和肝功能損害。電解質紊亂較為普遍。經1～2天治療,所有患者自覺癥狀消失、肝功能和心肌酶譜恢復正常,治愈出院。經2年隨訪,未發現不良癥狀。結論:山豆根中毒目前沒有特殊解毒藥,經對癥支持治療效果良好。為群體性急性山豆根中毒的

Influence of chronic alcohol intake on acute lung injury in rats

Objective To investigate the influence of chronic alcohol ingestion on the severity of acute lung injury (ALI) induced by oleic acid and lipopolysaccharide (LPS).Methods Thirty-two SD rats were randomly administrated with alcohol or water for 6 weeks，then instilled with oleic acid and LPS to induce ALI or with normal saline as control.Thus the rats were randomly divided into two injury groups [ethanol group and water group] and two control groups [ethanol group and water group] (n=8 in each group). PaO2,Wet to dry lung weight ratio (W/D)，levels of γ-glutamylcysteinylglycine (GSH) and malonaldehyde (MDA) in the lung tissue were measured.Results Compared to corresponding control groups，the PaO2 and GSH significantly decreased，and the lung W/D and MDA level were significantly increased in the injury groups (all Plt;0.05).In the injury groups，the changes of above parameters were more significant in the alcohol group than thoe in the water group (all Plt;0.05)，except the lung W/D with no significant difference.Conclusion Chronic ethanol ingestion was relevalent to oxidation/ antioxidation imbalance and more severe lung injury in rats with severe septic after trauma,which suggests that chronic alcohol abuse could increase the severity of acute lung injury.

嗎啡緩釋片直腸給藥致蓄積中毒一例

【摘要】　目的　報道并分析1例疼痛患者使用嗎啡緩釋片直腸給藥鎮痛過程中出現蓄積中毒的不良反應。　方法　采用病例報告的形式并結合藥品使用說明書進行分析。　結果　嗎啡緩釋片說明書上并未有直腸給藥途徑，該患者使用嗎啡緩釋片塞肛屬于超說明書用藥。　結論　在臨床中不推薦嗎啡緩控釋制劑作為直腸給藥，如果無法避免需要使用該途徑時，也應從小劑量開始逐漸增加劑量，尤其老年患者，應更加謹慎使用。

皮質盲二例

Advances in pathogenesis and early prediction of delayed encephalopathy caused by acute carbon monoxide poisoning

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.

妊娠高血壓綜合征頭位順產新生兒91例眼底檢查

Effects of the Galanthamine on NMDAR2B of Hippocampus Neuron in Acute Alcoholism of Rats

摘要:目的:探討加蘭他敏對急性酒精中毒大鼠海馬神經元N甲基D天冬氨酸(NMDA)·R2B的影響。 方法:將60只大鼠分為對照組、酒精組及加蘭他敏組,每組各20只。酒精組以50％(v/v) 酒精12 mL/kg灌胃兩次/日,共7d。加蘭他敏組酒精(濃度、劑量同上)灌胃的同時腹腔注射加蘭他敏2mg/kg一次/日,共7d。對照組以等量生理鹽水灌胃。實驗第8天取大鼠海馬區做蘇木精伊紅（HE）染色,觀察海馬區的病理學變化;免疫組織化學采用SABC法,觀察海馬區神經元NR2B的表達。 結果: 病理學觀察結果：對照組海馬區神經細胞排列整齊,胞質淡染,無變性、壞死;酒精組神經細胞層次不清、排列松散、細胞數量減少,部分細胞變性;加蘭他敏組神經細胞層次較清、排列較密,細胞數目較酒精組增; 免疫組織化學結果：酒精組與對照組比較NR2B陽性表達細胞數量明顯減少(Plt;0.01);加蘭他敏組與酒精組比較NR2B陽性表達細胞數量明顯增高(Plt;0.05);加蘭他敏組與對照組比較NR2B表達細胞數量無明顯差異(Pgt;005)。 結論: 急性酒精中毒與海馬區神經細胞的NR2B表達下調有關;加蘭他敏具有保護急性酒精中毒導致的大鼠海馬區神經細胞毒性的作用,其機制可能與加蘭他敏上調NR2B的表達有關。Abstract: Objective: To study the effects of galanthamine on NmethylDaspartic acid receptor 2B (NMDAR2B, NR2B) in the hippocampus (HIP) of acute alcoholism rats. Methods: Total of 60 wistar male rats were randomly divided into control group, ethanol group and glanthamine group, and there were 20 rats in each group. The rats in ethanol group were given by intragastric administration with 50% alcohol (v/v) on the dose of 12 ml/kg twice per day, in control group were given by same dose of saline, and in galanthamine group were treated by intragastric administration with the same concentration and dosage of alcohol as in ethanol group and peritoneal injection with 2 mg/kg of galanthamine once per day for 7 days. In eighth day of experiment, the rats were sacrificed under etherization, and pathological changes of HIP’s zone of rat were observed by HEstaining, and expression of NR2B in neurons of HIP’s zone by immunohistochemical SABC method. Results: The results observed by histopathology showed that in control group, neurons of HIP’s zone lined up in order, cytoplasm had faint staining, and were no degeneration and necrosis; in ethanol group, nerve cells’ layer was unclear, structure was loose, cell number reduced and part of cells degenerated; in galanthamine group, layer of neurons was comparatively clear and arrangement was comparatively dense, and the cell number increased obviously more than ethanol group. The results detected by Immunohistochemistry for NR2B showed that the cell number with expression of NR2B in the HIP’s zone decreased significantly in the ethanol group than in the control group (Plt;0.01), increased in the galanthamine group than in the ethanol group (Plt;0.05), and had no difference between the galanthamin and control group (Pgt;0.05). Conclusion: Acute alcoholism may relate to down regulation of expression of neuron’s NR2B in HIP’s zone;The galanthamin has role of protection for neuron in HIP’s zone induced by toxicity of acute alcoholism, and its mechanism may relate to galanthamin upregulation NR2B expression.