精品医学课件-食源性疾病和食物中毒完整版.pptVIP

Poisoning Mechanism 口腔与胃肠道粘膜吸收 作用于神经系统 阻断神经肌肉间的传导 使神经末梢和中枢神经麻痹。 　　　　　 感觉神经、运动神经麻痹 　　　　　 外周血管扩张，使血压急剧下降， 　　　　　 呼吸中枢和血管运动中枢麻痹而致死。 TTX is an especially potent neurotoxin, specifically blocking voltage-gated sodium channels on the nerve membranes surface. The TTX-Na Channel binding site is extremely tight (Kd = 10-10 nM). 河豚鱼中毒 Puffer fish poisoning Clinical Manifestation First symptom: slight numbness of the lips and tongue, appearing 20 min~3 hs after ingestion. Next symptom: increasing paraesthesia in the face and extremities, sensations of lightness or floating； Headache, epigastric pain, nausea, diarrhea, and/or vomiting; some reeling or difficulty in walking Third stage: increasing paralysis: unable move; even sitting difficult. Increasing dyspnea(呼吸困难) , affected speech and hypotension. Convulsions, mental impairment, and cardiac arrhythmia Death：within 4 to 6 hours, range 20 minutes to 8 hours 河豚鱼中毒 Puffer fish poisoning Emergency treatment 催吐：1% CuSO4 出现症状停止 洗胃：1/2000~4000KMnO4或1 ~3%NaHCO3 导泻：50% MgSO4 50ml 对症治疗： 早期解毒：L-半胱氨酸盐酸盐静脉滴注 呼吸困难：洛贝宁、尼可刹米注射 肌肉麻痹：士的宁、番木鳖碱 保肝解毒：高渗葡萄糖输液 河豚鱼中毒 Puffer fish poisoning Preventive measures 禁止食用新鲜河豚鱼 河豚鱼鱼干经鉴定后食用 新鲜河豚鱼统一收购 →去皮→去头、内脏→切片→腌渍（20%）1-2d →漂洗→出晒→鱼干 开展宣传教育，改变饮食习惯 避免误食中毒 河豚鱼中毒 Puffer fish poisoning 家庭自制河豚鱼要不得 河豚鱼集中处理 严防河豚鱼混入市场 中毒后立即接受治疗 Poisoning Mechanism 有毒藻类（膝沟藻等，海水富营养化和赤潮时大量繁殖）　　　 贝类摄入（毒素呈结合状态，对贝类无毒） 人类摄入（毒素解离，呈现毒作用） Character of toxin：saxitoxin 白色、耐热、易溶于水、易吸收 小分子非蛋白类毒素 麻痹性贝类中毒Paralytic shellfish poisoning Poisoning Mechanism 组氨酸是深色鱼（金枪鱼，鲭鱼）的优势氨基酸，含量0.6 %～1.3%，甚至2% 浅色鱼肉游离组氨酸0.005 % ～0.05% foods such as fishery products, particularly tuna, rich in histidine certain bacteria growth: spoilage Decarboxylase 脱羧酶 enzymes on histidine and other amino acids foods contain high levels of histamine and possibly other vasoactive amines and compounds 鱼类组胺中毒 Fish histamine poisoning Clinical Manifestation发病急，症状轻，恢复快　 Initial