大黄和维库溴铵救治急性毒鼠强中毒的临床研究  

A clinical study on rhubarb and vecuronium bromide in acute tetramine intoxication

作　　者：张希洲[1] 刘军 杨兴易[3] 王青丽[1] 郑昌林[1] 戴敏[1] 伍凌[1] 周文[1] 张冬仿[1] 

机构地区：[1]湖北省宜昌市第一人民医院,宜昌443000 [2]宜昌市疾病控制中心 [3]上海市第二军医大学长征医院急救科

出　　处：《中华急诊医学杂志》2004年第8期542-544,i003,共4页Chinese Journal of Emergency Medicine

摘　　要：目的　探索大黄和维库溴铵在救治急性毒鼠强中毒 (ATI)时的临床应用效果。方法　将确诊为ATI功患者 99例随机分成大黄组 5 1例和对照组 4 8例。所有患者均在确诊后 ,应用二巯基丙磺钠 (Na -DMPS) ,并立即经鼻气管插管 ,然后插胃管洗胃 ,洗胃完毕 ,保留胃管。对照组应用 2 0 %甘露醇导泻 ,应用安定 1 0 0mg和苯妥英钠 4 0 0mg静脉注射控制抽搐。大黄组经胃管灌注入生大黄 2 0mg,每 6h一次 ;在同样的机械通气的前提下 ,立即静脉推注维库溴铵 0 8mg/kg ,然后以 1 0 μg/(kg·min)速度持续静脉泵注控制抽搐。动态检测入院时、入院后 1 2、 2 4、 4 8和 72h的血清毒鼠强浓度。结果　大黄组血清毒鼠强的浓度明显低于对照组 (P <0 0 1 ) ,对照组脏器功能受损程度明显高于大黄组 (P <0 0 1 )。大黄组无死亡 ,预后好 ;对照组死亡 3例 ,中枢性肺水肿 3例 ,1例留有严重的精神分裂症 ,1例痴呆。结论　在急性毒鼠强中毒时 ,有效清除胃内容物非常重要 ,彻底导泻也不能忽视。大黄能有效地清除胃内毒物 ,同时能减轻毒鼠强的二次中毒的病理生理过程 ,在脏器功能的保护中起到了非常重要的作用。另外 ,控制持续抽搐至关重要 ,在机械通气的同时应用维库溴铵控制抽搐迅速彻底 。Objective To evaluate the clinical effect of rhubarb and vecuronium bromide in acute tetramine intoxication (ATI) patients.Methods 99 patients were randomized into control group and rhubarb group.After confirming diagnosis of ATI,patcents in both groups,Control group was treated with nasogostric 20%mannitol and iv valium.Rhubarb group Rhubarb and iv vecuronium bromide 10 μg/(kg·min).Blood serum tetramine at once,12,24,48 and 72 hours later.Results serum Tetramine of blood in Rhubarb group was lower than control group ( P <0 01). There was no second intoxication,in control group. Marker of organ function increased significantly in both groups but more. in Control group.Conclusions Treatment of etiological factor is very important in acute tetramine intoxication (ATI),treating of convulsions and breathing support are the key.We must estalblish a patient airway as soon as possible,using Rhubarbs and Vecuronium bromide and mechanical ventilation to prevent acute respiratory distress,SIRS and MODS caused by low oxygen,improve recovery reduce the mortality rate in the AIT patients.

关 键 词：大黄 维库溴铵 救治 急性毒鼠强中毒 洗胃 

分 类 号：R595[医药卫生—内科学]