机械通气并血液灌流治疗重度钩吻中毒的效果  

MECHANICAL VENTILATION COMBINED WITH HEMOPERFUSION FOR GELSEMISM

作　　者：廖达林[1] 张伟[1] 

机构地区：[1]中国人民解放军南京军区福州总医院急诊科,福建福州350025

出　　处：《齐鲁医学杂志》2015年第5期564-566,共3页Medical Journal of Qilu

基　　金：南京军区"十二五"科研项目(Z1409)

摘　　要：目的总结钩吻中毒临床救治经验。方法回顾分析我科收治的10例钩吻中毒病人的临床资料,分析其临床特点和救治措施。结果本组10例病人经口服中毒9例,经灌肠中毒1例。中度钩吻中毒1例,重度钩吻中毒8例。均在服用钩吻10～30min出现中毒症状,主要表现为头晕、乏力,呼吸困难甚至呼吸麻痹,恶心、呕吐,腹痛,发绀,意识模糊甚至昏迷,视力模糊,呼吸心搏骤停。本组出现呼吸抑制8例,中枢抑制5例,心搏骤停1例。入院后在补液、利尿、洗胃、导泻、呼吸机辅助呼吸和稳定循环的基础上,及时给予血液灌流。机械通气时间为（26±10）h,血液灌流时间为（3.5±1.0）h,住院时间（8±3）d。救治成功9例,死于多器官功能障碍综合征1例。随访3～6个月,无后遗症。结论钩吻中毒容易导致呼吸衰竭,进而发生心搏骤停及多脏器功能障碍综合征。早期开放气道、机械通气、血液灌流清除毒物是救治的有效方法。Objective To summarize the experience of remedy for gelsemism. Methods A retrospective review of clinical data of 10 patients with gelsemism was carried out,and the clinical features and measures of remedy analyzed. Results Of this 10 patients,nine were oral poisoning,one due to enema,of whom,eight with severe intoxication,and one with moderate.All of them appeared toxic symptoms 10-30 min after taking gelsemium elegans,main manifestations being dizziness,lack of power,dyspnea even respiratory paralysis,nausea,vomiting,confusion even coma,visual disturbance,or respiratory and cardiac arrest.Eight patients with respiratory depression,five with central inhibition,and one with cardiac arrest.On admission,all patients were given fluid infusion,diuresis,gastric lavage,catharsis,assisted respiration and stabilized circulation,a blood infusion was then given promptly.Time of mechanical ventilation was（26±10）h,hemoperfusion time was（3.5±1.0）h and hospital stay was（8±3）d.Nine patients were successfully rescued,one died of multiple organ failure.A follow-up of 3-6months showed no sequel. Conclusion Gelsemism is easy to lead to respiratory failure,and thus to cause cardiac arrest and multiple organ failure.An early opening of airway to carry out mechanical ventilation,and blood infusion to remove poisons are effective methods for rescue.

关 键 词：植物中毒 钩吻 呼吸 人工 透析 

分 类 号：R595.9[医药卫生—内科学]