敌草快混合百草枯中毒的急救与护理  

Emergency treatment and nursing for diquat and paraquat poisoning

作　　者：黄明榕 唐亚慧[1] 吴莉娜 陈潇荣 吴斌[1] 卢中秋[1] 胡颖颖[1] Huang Mingrong;Tang Yahui;Wu Lina;Chen Xiaorong;Wu Bing;Lu Zhongqiu;Hu Yingying(Department of Emergency,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,China)

机构地区：[1]温州医科大学附属第一医院急诊科,浙江温州325000

出　　处：《中国中西医结合急救杂志》2024年第4期478-481,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：浙江省临床重点专科急诊医学科建设项目(2023-12-27);浙江省温州市科研项目(Y20220578)。

摘　　要：目的分析敌草快混合百草枯中毒患者的急救方案与护理措施,为今后临床工作提供参考.方法采用回顾性研究方法,选择2019年1月1日至2023年12月31日温州医科大学附属第一医院急诊科收治的53例敌草快混合百草枯中毒患者作为研究对象.将患者按预后分为生存组和死亡组,收集临床资料,比较不同预后两组患者器官功能受损情况,以及使用血液灌流(HP)比例、使用灌流器平均数、血液净化比例、平均血液净化时间和HP串联连续性肾脏替代治疗(CRRT)比例的差异.结果53例敌草快混合百草枯中毒患者中男性27例(50.94%),女性26例(49.06%);年龄14~86岁,平均(38.13±19.68)岁.52例为自行口服中毒,1例为误服.检测出的敌草快血药浓度57.38~119762.00μg/L,百草枯血药浓度60.12~71244.89μg/L.40例患者出现了不同程度的多器官功能障碍综合征(MODS),其中38例最终进展为多器官衰竭,以消化道、肾脏、肝脏等靶器官损伤为主;经积极救治和护理后,13例(24.53%)患者两种药物血药浓度均下降至<50μg/L,最终好转出院,住院4~34 d;32例患者家属放弃治疗自动出院,随访后确认死亡,住院1~4 d;8例患者院内死亡,住院1~3 d,共死亡40例(75.47%).与生存组比较,死亡组患者神经系统、肾脏、呼吸系统、肝脏损伤率均明显升高[神经系统:90.00%(36/40)比15.38%(2/13),肾脏:95.00%(38/40)比69.23%(9/13),呼吸系统:97.50%(39/40)比30.77%(4/13),肝脏损伤:85.00%(34/40)比46.15%(6/13),均P<0.05];与生存组比较,死亡组使用灌流器平均数、平均血液净化时间均明显降低[使用灌流器平均数(个):4.35±2.42比6.62±1.17,平均血液净化时间(d):1.53±1.09比5.23±3.90,均P<0.05].结论敌草快混合百草枯中毒病情凶险,病死率高,实施系统性治疗的同时给予个体化、动态化护理支持,密切观察受累器官系统的表现与检验指标,优化死亡高峰期流程,以期降低敌草快混合百草枯患者病死率.Objective To analyze the emergency treatment protocols and nursing measures for patients with diquat and paraquat poisoning,aiming to provide references for updating future clinical practice.Methods A retrospective study was conducted involving 53 patients with diquat and paraquat poisoning admitted to the department of emergency of the First Affiliated Hospital of Wenzhou Medical University from January 1,2019,to December 31,2023.The patients were divided into survival and death groups based on their prognosis.Clinical data were collected to compare organ dysfunction,the proportion of hemoperfusion(HP),average number of HP sessions,the proportion of blood purification,average duration of blood purification,and the proportion of HP combined with continuous renal replacement therapy(CRRT)between two groups of patients with different prognoses.Results Among the 53 patients,27(50.94%)were male and 26(49.06%)were female;with an age range of 14 to 86 years and a mean age of(38.13±19.68)years.Fifty-two cases were due to intentional ingestion,and 1 was accidental.The detected blood concentrations of diquat ranged from 57.38 to 119762.00μg/L,while those of paraquat ranged from 60.12 to 71244.89μg/L.Forty patients developed multiple organ dysfunction syndrome(MODS),with 38 ultimately progressing to multiple organ failure,primarily affecting the gastrointestinal tract,kidneys,and liver.After aggressive treatment and nursing,the blood concentrations of 13 patients(24.53%)dropped below 50μg/L,and they were discharged after 4 to 34 days of hospitalization.Thirty-two patients'families opted for withdrawal of treatment and discharge,with subsequent confirmation of death after follow-up,hospital stay:1-4 days.Eight patients died in-hospital,hospital stay:1-3 days,resulting in a total mortality rate of 40 cases(75.47%).Compared to the survival group,the death group had significantly higher rate of neurological,renal,respiratory,and liver injuries[neurological:90.00%(36/40)vs.15.38%(2/13),renal:95.00%(38/40)vs.69.23%(9/13),res

关 键 词：中毒 敌草快 百草枯 混合中毒 护理 

分 类 号：R595[医药卫生—内科学]