5例重症急性敌草快中毒患者治疗护理体会  

Nursing experience in the treatment of 5 patients with severe acute dipyridamole poisoning

作　　者：左冬晶 段云娇 袁伟[1] Zuo Dongjing;Duan Yunjiao;Yuan Wei(Department of Emergency,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院急诊科,北京100020

出　　处：《中国中西医结合急救杂志》2023年第1期93-95,共3页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

摘　　要：目的总结5例重症急性敌草快(DQ)中毒患者的病例特点及治疗护理经验,为DQ中毒患者的观察与护理提供临床指导。方法2020年9月至2021年9月首都医科大学附属北京朝阳医院急诊科共收治5例重症急性DQ中毒患者,收集其临床资料,分析患者的器官功能损伤情况及系统性护理支持,并总结护理经验。结果5例重症急性DQ中毒患者中男性4例,女性1例;年龄22~39岁,平均30.6岁;5例患者均存在多器官功能损伤,其中2例为神经系统损伤(考虑中毒性脑病),2例出现低氧血症,5例出现消化道出血与黏膜损伤,4例出现肝功能损伤,5例出现急性肾损伤(AKI)。2例患者分别于治疗第3天和第5天出现神经系统损伤,给予甲泼尼龙抗炎、甘露醇脱水降颅压、维生素B1及B2营养神经等治疗。对2例严重低氧血症患者给予气管插管、机械振动排痰,严格限制吸氧(供氧浓度维持在21%~40%),以免产生过度的过氧化反应,加重损伤,经治疗,分别于入院后第10天和第12天拔除气管插管。消化道黏膜损伤为DQ中毒常见并发症,表现隐匿,虽初期表现轻微,随病情演变及多种药物使用,尤其在使用糖皮质激素后可能加重胃肠黏膜损伤引起大出血,要每日观察胃内容物及大便。注意皮肤黏膜情况及黄疸,以防肝损伤。连续性静脉-静脉血液滤过(CVVH)可促进毒物从体内排出,严格控制血液净化治疗中的液体出入量,维持血钙浓度在正常范围,严格无菌操作,预防导管相关性感染。2例患者经过系统性护理治疗,各器官功能得以恢复,康复出院;1例患者中途放弃治疗;2例死亡。结论DQ中毒临床表现个体化差异较大,各器官损伤程度轻重不一,应在实施系统性护理支持的基础上,密切观察患者临床表现与理化指标,并予以个体化、动态调整的护理措施,以求获得最佳的临床结局。Objective To summarize the characteristics of five patients with acute diquat(DQ)poisoning and the nursing experience of treatment,and provide clinical guidance for the observation and nursing of DQ poisoning patients.Methods From September 2020 to September 2021,five patients with acute DQ poisoning were admitted to the emergency department of Beijing Chaoyang Hospital.Their clinical data were collected,their organ function injuries and systemic nursing method were analyzed,and nursing experience was summarized.Results Among the 5 patients with severe acute DQ poisoning,4 were male and 1 was female.The age ranged from 22 to 39 years,with an average of 30.6 years.All 5 patients had multi-organ function injury,including 2 patients with nervous system injury(considered as toxic encephalopathy),2 patients with hypoxemia,5 patients with gastrointestinal bleeding and mucosal injury,4 patients with liver function injury,and 5 patients with acute kidney injury(AKI).Two patients suffered from nervous system injury separately on the 3rd and 5th day of treatment,and were treated with methylprednisolone for anti-inflammatory,mannitol dehydration to reduce intracranial pressure,and vitamin B1 and B2 to nourish nerves.For 2 patients with severe hypoxemia,endotracheal intubation and mechanical vibration expectoration were used,but oxygen inhalation was strictly limited(the oxygen supply concentration was maintained at 21%-40%)to avoid excessive peroxide reaction to aggravate the injury.After treatment,their tracheal intubation was removed on the 10th and 12th day after admission.Gastrointestinal mucosal injury is a common complication of DQ poisoning,and its performance is concealed.Although the initial performance is slight,it may aggravate gastrointestinal mucosal injury and cause massive hemorrhage with the development of disease and the use of various drugs,so the contents of stomach and the characteristics of stool were observed strictly and regularly,especially after the use of glucocorticoids.Pay attention to the condit

关 键 词：敌草快中毒 中毒性脑病 急性肾损伤 护理 

分 类 号：R595[医药卫生—内科学]