急性重度有机磷农药中毒急救探讨 毕业论文.docVIP

急性重度有机磷农药中毒急救探讨 【摘要】：有机磷农药中毒的机理，一般认为是抑制了胆碱酯酶的活性，造成组织中乙酰胆碱的积聚，其结果引起胆碱能受体活性紊乱，而使有胆碱能受体的器官功能发生障碍。凡由脏器平滑肌、腺体、汗腺等兴奋而引起的症状，与毒蕈中毒所引起的症状相似，则称为毒蕈样症状；凡由交感神经节和横纹肌活动异常所引起的症状，与烟碱中毒所引起的症状相似，故称烟碱样症状。 急性有机磷农药中毒是内科的常见急病之一,尤其是重度患者早期即出现呼吸循环衰弱,故早期基本生命支持,彻底洗胃,合理使用阿托品,是抢救成功的关键。 【关键词】　有机磷农药; 机理， 中毒; 急性; 急救 【Abstract】 Objective: The mechanism of organophosphorus pesticide poisoning,Is thought to inhibit the activity of cholinesterase, resulting in tissue accumulation of acetylcholine, the result of cholinergic receptor activity caused by disorder, leaving a muscarinic receptor that barriers to organ function.Where the organ smooth muscle, glands, sweat glands and other symptoms caused by excitement, and the symptoms of mushroom poisoning caused by similar, then known as the mushroom-like symptoms; where the sympathetic ganglia and striated muscle symptoms caused by abnormal activities, andsymptoms of nicotine poisoning caused by similar nicotine-like symptoms, it said.Acute organophosphorus pesticide poisoning is a common acute disease of internal medicine, especially in the early stage of severe respiratory cycle in patients with debilitating, it is early basic life support, thorough gastric lavage, the rational use of atropine, is the key to successful treatment. 【Key words】 Organophosphorus pesticides; Mechanism; Poisoning，Acute，First aid 1　临床资料本组28例,男3例,女25例;年龄21~68岁,除1例是被泼撒外,其余均因企图自杀而口服有机磷农药10~50 m,l均产生急性中毒症状与体征,其中1605中毒1例,敌敌畏中毒5例,甲胺磷中毒6例,乐果中毒6例,氧化乐果中毒9例,除草剂中毒1例,口服中毒患者均在院前洗胃后入院。依据有机磷杀虫剂急性中毒分级标准:轻度中毒3例,中度中毒10例,重度中毒15例。因呼吸衰竭气管插管6例,气管切开2例。经过抢救治疗后,治愈23例,死亡5例。 2　一般急救处理 2·1　早期迅速彻底清除毒物　皮肤中毒患者要迅速去除污染衣服、鞋袜,及时冲洗患者头发、皮肤、指甲,以阻止毒物从皮肤吸收。对口服农药者应彻底洗胃后保留胃管,持续引流胃液并多次少量液体洗胃, 2~3 d后引流液无农药味时拔出胃管,是抢救有机磷农药中毒第一个至关重要的环节。因为:①胃皱襞内残留毒物随胃蠕动再次排入胃腔;②在抢救有机磷农药中毒时使用 大量阿托品,胃肠蠕动减弱或消失,肠腔扩张,肠道内酵解产生,压力增高,已进入肠内的有机磷(或肝肠循环进入肠道的有机磷)返流入胃;③某些有机磷农药如乐果进入人体内经氧化酶作用缓慢转化成毒性更大的氧化乐果,再分泌入胃内,这样造成有机磷体内的再吸收。所以,应提倡保留胃管反复洗胃,每次灌液不能太大,一般200~300 m,l然后再抽吸,抽出量等于入量,如此间断灌洗直至引流液无农药味止。洗胃后灌入20甘露醇125~250 ml导泻,以促使肠道内毒物排出。 2·2　解毒剂的应用