【摘要】：目的:通過選擇我院急診科首診的口服有機(jī)磷農(nóng)藥中毒患者,按照有機(jī)磷農(nóng)藥中毒診療規(guī)范,給予反復(fù)洗胃、導(dǎo)瀉清除胃腸道內(nèi)殘留毒物,阿托品對(duì)抗毒蕈堿樣癥狀,氯解磷定恢復(fù)膽堿酯酶活力,保護(hù)胃粘膜及促進(jìn)血液內(nèi)毒物代謝,必要時(shí)呼吸機(jī)輔助呼吸等綜合治療的基礎(chǔ)上,同時(shí)配合應(yīng)用經(jīng)皮電刺激足三里穴位治療,觀察臨床導(dǎo)瀉效果及減少嘔吐不良反應(yīng)的作用,觀察對(duì)心、肝等重要臟器的保護(hù)和降低不良并發(fā)癥發(fā)生率的作用,觀察治療效果及治愈率,并監(jiān)測操作過程對(duì)機(jī)體血流動(dòng)力學(xué)的影響及有無暈針、皮膚損傷等不良事件,以評(píng)價(jià)經(jīng)皮穴位電刺激足三里對(duì)有機(jī)磷農(nóng)藥中毒患者搶救治療作用及其安全性。方法:選擇2013年9月~2014年12月邢臺(tái)市人民醫(yī)院急診科首診的口服有機(jī)磷農(nóng)藥中毒患者62例,按照單純隨機(jī)抽樣分組原則分為試驗(yàn)組和對(duì)照組各31例,兩組患者均按照有機(jī)磷農(nóng)藥中毒診療規(guī)范給予綜合治療,包括反復(fù)洗胃、導(dǎo)瀉清除胃腸道內(nèi)殘留毒物,阿托品對(duì)抗毒蕈堿樣癥狀,氯解磷定恢復(fù)膽堿酯酶活力,保護(hù)胃粘膜及促進(jìn)血液內(nèi)毒物代謝,必要時(shí)建立人工氣道、呼吸機(jī)輔助呼吸和血液透析治療等。試驗(yàn)組在洗胃后胃管內(nèi)注入甘露醇導(dǎo)瀉和藥用炭片吸附毒物前,配合應(yīng)用經(jīng)皮電刺激雙側(cè)足三里穴位,1次/8h,30min/次,對(duì)照組常規(guī)應(yīng)用導(dǎo)瀉劑和吸附劑。觀察兩組患者首次徹底洗胃后胃管內(nèi)注入導(dǎo)瀉劑所致的嘔吐發(fā)生率,應(yīng)用導(dǎo)瀉劑后首次大便時(shí)間和排出黑便時(shí)間,導(dǎo)瀉期間每日排便次數(shù),達(dá)到阿托品化時(shí)間及阿托品使用總量,膽堿酯酶活力恢復(fù)時(shí)間,發(fā)生呼吸衰竭給予氣管插管、呼吸機(jī)治療率,觀察血清CK、CK-MB、LDH值3d后變化評(píng)估心肝等重要臟器損傷細(xì)胞恢復(fù)情況,兩組患者住院時(shí)間、治愈率和死亡例數(shù),試驗(yàn)組行經(jīng)皮穴位電刺激治療前、1min、5min及治療后心率(H)、收縮壓(SBP)、舒張壓(DBP)、平均動(dòng)脈壓(MBP)及末梢血氧飽和度(Sp O2)變化,并觀察治療過程中有無不良事件如:局部皮膚損傷、肌肉酸痛、暈針等反應(yīng)發(fā)生,以評(píng)價(jià)此治療技術(shù)的安全性。結(jié)果:兩組患者首次徹底洗胃再胃管內(nèi)注入導(dǎo)瀉劑后的嘔吐情況比較,對(duì)照組嘔吐發(fā)生率明顯高于試驗(yàn)組,兩組比較差異有統(tǒng)計(jì)學(xué)意義{32.2%(10例)比9.7%(3例),P0.05},兩組患者首次大便時(shí)間、首次排出黑便時(shí)間比較,試驗(yàn)組首次排便時(shí)間、首次排出黑便時(shí)間明顯縮短,兩組比較差異有統(tǒng)計(jì)學(xué)意義(h:9.3±3.6比11.6±5.2,11.3±5.3比14.5±6.8,均P0.05);導(dǎo)瀉期間排便次數(shù)試驗(yàn)組多于對(duì)照組(次/d:4.3±0.53比3.1±0.41,P0.01);兩組患者達(dá)到阿托品化時(shí)間、阿托品使用總量和血清膽堿酯酶恢復(fù)到正常1/2時(shí)間比較,比較差異有統(tǒng)計(jì)學(xué)意義(h:4.2±2.8比6.6±3.5,mg:66.3±22.8比84.6±24.2,d:6.1±2.4,比8.3±3.9,P0.01);兩組患者呼吸機(jī)治療率(13%比35%)和平均住院時(shí)間(d:11.3±2.8比13.4±4.2)比較,試驗(yàn)組優(yōu)于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05);兩組患者治療3d后測定血清CK、CK-MB、LDH值變化比較,試驗(yàn)組明顯優(yōu)于對(duì)照組(u/L:925.1±130.2比1252.1±159.3,28.8±9.1比35.2±12.6,223.9±28.9比315.2±37.4,P0.05);試驗(yàn)組行經(jīng)皮穴位電刺激治療前、1min、5min及治療后心率(H)、收縮壓(SBP)、舒張壓(DBP)、平均動(dòng)脈壓(MBP)及末梢血氧飽和度(Sp O2)變化不明顯,治療后與治療前比較差異無統(tǒng)計(jì)學(xué)意義{心率(次/min):119.1±8.1、116.2±8.7、120.1±9.1比118.2±10.9,收縮壓(mm Hg,1 mm Hg=0.133 k Pa):118.8±19.1、116.6±16.0、118.8±18.1比115.6±16.8,舒張壓(mm Hg):80.9±15.8、78.5±17.9、77.2±18.2比76.1±17.2,平均動(dòng)脈壓(mm Hg):96.7±17.5、97.4±18.5、98.0±18.2比95.9±19.5,Sp O2(%):93.3±2.8、94.9±3.2、94.2±3.1比94.2±4.2,均P0.05}。經(jīng)皮穴位電刺激治療過程中未見局部皮膚損傷、暈針、肌肉酸痛等不良反應(yīng)發(fā)生,說明此項(xiàng)操作是安全的。結(jié)論:1口服有機(jī)磷農(nóng)藥中毒的患者在給予洗胃、導(dǎo)瀉劑及綜合治療的基礎(chǔ)上,采用中西醫(yī)結(jié)合治療理論,配合經(jīng)皮電刺激足三里穴,可降低導(dǎo)瀉劑應(yīng)用后嘔吐發(fā)生率,增強(qiáng)導(dǎo)瀉效果,促使胃腸道內(nèi)毒物盡快排出。2有機(jī)磷農(nóng)藥中毒的患者配合經(jīng)皮電刺激足三里穴治療,可減少住院期間阿托品使用總量,縮短達(dá)到阿托品化時(shí)間,縮短患者住院時(shí)間,促進(jìn)血清膽堿酯酶活力的恢復(fù),保護(hù)心、肝等重要臟器細(xì)胞,提高臨床治療效果。3經(jīng)皮穴位電刺激治療對(duì)機(jī)體影響小,無不良反應(yīng)及暈針等意外情況發(fā)生,是安全有效的治療措施,為臨床搶救口服有機(jī)磷農(nóng)藥中毒患者胃腸道毒物盡早、安全的清空和提高臨床療效提供了一種方便、安全、有效的方法。
[Abstract]:Objective: by selecting the patients with orally organophosphorus pesticide poisoning in the first diagnosis of the emergency department of our hospital, according to the diagnosis and treatment of organophosphorus pesticide poisoning, repeated gastric lavage, catharsis to remove the toxic substances in the gastrointestinal tract, atropine to antagonize the muscarinic symptoms, to restore the activity of cholinesterase, protect the gastric mucosa and promote the metabolism of the blood in the blood. On the basis of ventilator assisted breathing and other comprehensive treatment, combined with the application of percutaneous electric stimulation of Zusanli acupoint treatment, the effect of clinical catharsis and the effect of reducing the adverse reaction of vomiting were observed, the protection of important organs such as heart, liver and other important organs were observed and the effect of reducing the incidence of adverse complications was observed, the therapeutic effect and cure rate were observed, and the operation was monitored. The effect and safety of the percutaneous acupoint electrical stimulation of Zusanli on the patients with organophosphorus pesticide poisoning and its safety were evaluated by the influence of the course on the hemodynamics of the body and the safety. Methods: 62 cases of oral organophosphorus pesticide poisoning in the first emergency department of Xingtai People's Hospital in September 2013, December ~2014, were selected. According to the principle of random sampling, 31 cases were divided into the experimental group and the control group. The two groups were given comprehensive treatment according to the diagnosis and treatment of organophosphorus pesticide poisoning, including repeated gastric lavage, catharsis cleaning the residual poison in the gastrointestinal tract, atropine against the symptoms of muscarinic, cholinesterase recovery of cholinesterase activity, the protection of gastric mucosa and the promotion of blood. An artificial airway, ventilator assisted respiration and hemodialysis were established when necessary. The experimental group was injected with mannitol catharsis and Medicinal Charcoal Tablets to adsorb the poison in the gastric tube after gastric lavage, combined with the application of percutaneous electric stimulation of the bilateral Zusanli points, 1 times /8h, 30min/ times, and the control group was routinely used for catharsis and adsorbents. The two groups were observed. The incidence of vomiting caused by catheterization was injected into the gastric tube after the first thorough gastric lavage. The time of first stool after catharsis and the time of excreting the black stool, the number of daily defecation times during the catharsis, atropine time and the total amount of atropine, the recovery time of cholinesterase activity, tracheal intubation and ventilator therapy for respiratory failure were given. Rate, observe the changes of serum CK, CK-MB, LDH value after 3D to evaluate the recovery of important organ damage cells, the time of hospitalization, the cure rate and the number of deaths in the two groups. Before the percutaneous acupoint electrical stimulation, 1min, 5min and the heart rate (H), systolic pressure (SBP), diastolic pressure (DBP), mean arterial pressure (MBP) and peripheral oxygen saturation (Sp O2) were performed in the experimental group. Change, and observe whether there are adverse events in the treatment process, such as local skin injury, muscle soreness, and needle sickness, to evaluate the safety of the treatment technology. Results: the vomiting of the two groups of patients after the first thorough gastric lavage and gastric canal injection of cathartic agent, the incidence of vomiting in the control group was significantly higher than that in the experimental group, the two groups were more different than the experimental group. There were statistically significant {32.2% (10 cases) compared with 9.7% (3 cases), P0.05}, two group for the first time of defecation, the first excretion time of the test group, the first defecation time, the first discharge of the black stool time obviously shortened, the two groups were statistically significant (h:9.3 + 3.6 to 11.6 + 5.2,11.3 + 5.3 ratio 14.5 + 6.8, P0.05); the times of defecation during the cathartic period test The test group was more than the control group (/d:4.3 + 0.53 / 3.1 + 0.41, P0.01); the two groups reached atropine time, the total amount of atropine and the recovery of serum cholinesterase to the normal 1/2 time, the difference was statistically significant (h:4.2 + 2.8, 6.6 + 3.5, mg:66.3 22.8, 84.6 + 24.2, d:6.1 + 0.41, P0.01); The rate of treatment (13% to 35%) and the average time of hospitalization (d:11.3 + 2.8 13.4 + 4.2) were better than those in the control group. The difference was statistically significant (P0.05). The changes of serum CK, CK-MB, LDH values in the two groups were significantly better than those in the control group (u/L: 925.1 + 130.2 compared with 1252.1 + 159.3,28.8 + 9.1 / 9.1 / 35.2 + 12.6223.9 + 28.9) 315.2 Before the treatment of percutaneous acupoint electrical stimulation, 1min, 5min and heart rate (H), systolic pressure (SBP), diastolic pressure (DBP), mean arterial pressure (MBP) and terminal blood oxygen saturation (Sp O2) were not significant before treatment. The difference was not statistically significant {heart rate (secondary /min) before treatment: 119.1 + 8.1116.2 + 8.7120.1 + 9.1 to 118.2 + 10.9 after treatment. Systolic pressure (mm Hg, 1 mm Hg=0.133 K Pa): 118.8 + 19.1116.6 + 16.0118.8 + 18.1 / 115.6 + 16.8, diastolic pressure (mm Hg): 80.9 + 15.8,78.5 + 18.2 ratio 76.1 + 17.2, average arterial pressure (96.7 +% + 18.2 ratio 95.9 + 19.5,%) There is no local skin injury, acupuncture, muscle pain and other adverse reactions in the process of irritation. Conclusion: 1 patients with orally organophosphorus pesticide poisoning are treated by combination of traditional Chinese and Western Medicine on the basis of gastric lavage, catharsis and comprehensive treatment, combined with percutaneous electric stimulation of the Zusanli point, which can reduce catharsis The incidence of postoperative vomiting, enhancing the effect of catharsis, prompting the gastrointestinal toxicants to expel.2 organophosphorus pesticide poisoning as soon as possible combined with the percutaneous electric stimulation of Zusanli, can reduce the total amount of atropine during hospitalization, shorten the atropine time, shorten the patient's hospitalization time, promote the recovery of serum cholinesterase activity, and protect the recovery of the serum cholinesterase activity. Heart, liver and other important organ cells to improve the effect of clinical treatment..3 percutaneous acupoint electric stimulation therapy has little influence on the body, no adverse reaction and acupuncture. It is a safe and effective treatment measure. It provides a safe and effective treatment for patients with oral organophosphorus pesticide poisoning. Convenient, safe and effective method.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R595.4

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