报道1例百草枯中毒合并气胸、纵隔气肿患者的临床表现及救治过程,并进行了长达3年的随访.提示尿百草枯浓度监测下的目标导向血液净化有助于救治的精准化,百草枯所致肺损伤在一定程度上是可逆的.

Mistakenly picking and eating poisonous mushrooms can cause acute poisoning. In August 2020, Qingdao Hospital of Traditional Chinese Medicine handled a poisonous mushroom poisoning incident, conducted epidemiological investigation on all poisoned patients, collected suspicious food, clinical manifestations, clinical test results and treatment conditions, and identified the mushrooms as Amanita fuliginea poisoning after morphological identification. In this incident, 6 people ate grey goose paste, of which 4 were sick with a incubation period of 6~12 h. The clinical manifestations were gastrointestinal symptoms such as nausea, vomiting and diarrhea, liver and kidney damage. After symptomatic support treatment, hemoperfusion or continuous hemofiltration treatment, the patients were cured and discharged. It is suggested to strengthen the popular science education on poisonous mushroom poisoning and improve the ability of identification and clinical treatment of poisonous mushrooms in grass-roots medical institutions.

Patients with organophosphate poisoning usually die from respiratory depression and respiratory failure. The incidence of rhabdomyolysis is relatively low, but the mortality rate is extremely high once it occurs. In this paper, the treatment of a patient with acute phoxim poisoning was analyzed. The patient developed severe rhabdomyolysis syndrome on the 3rd day of treatment, the creatine kinase exceeded the normal value by more than 300 times (up to 103510.65 U/L) , and renal failure occurred. Clinical treatment included active detoxification, blood purification, organ support, and internal environment maintenance. The patient's rhabdomyolysis continued, and the condition worsened. Finally, the family gave up the treatment and the patient died. It is suggested that attention should be paid to the occurrence of rhabdomyolysis syndrome during the treatment of organophosphorus poisoning, and timely blood purification technology may be the key to treatment.

目的 观察参附注射液联合亚低温治疗心脏骤停(CA)患者的临床效果.方法 选取2015年1月～2018年12月山东省青岛市海慈医疗集团收治的138例CA患者作为研究对象,按照随机数字表法将其分为对照组和观察组,每组69例.对照组给予亚低温(32～34℃)治疗,观察组在对照组基础之上,再静脉输注100 mL的参附注射液.心肺复苏后30 min、2h、12h和24 h采用酶联免疫法检测超氧岐化酶(SOD)、一氧化氮(NO)、丙二醛(MDA)、神经元特异性烯醇化酶(NSE)、人S100B蛋白(S-100B);CA 12、24、48、72 h检测患者脑氧代谢指标,包括动静脉血氧含量差(Ca-jvO2)、颈静脉球部血氧饱和度(SjvO2)和脑氧摄取率(CERO2);采用格拉斯哥昏迷量表(GCS)评估患者的昏迷状态;统计复苏有效率和病死率.结果 与复苏后30 min比较,对照组复苏2、12、24 h,SOD和NO水平明显下降,MDA水平明显升高,差异均有统计学意义(均P＜0.05).与复苏后30 min比较,观察组复苏2、12、24 h,SOD水平明显下降,NO和MDA水平明显升高,差异均有统计学意义(均P＜0.05).与复苏后30 min比较,两组患者复苏后2、12、24 h,NSE和S-100B水平均明显升高,差异均有统计学意义(均P＜0.05).复苏后2、12、24 h观察组SOD和NO水平明显高于对照组,MDA、NSE和S-100B水平明显低于对照组,差异均有统计学意义(均P＜ 0.05).与CA 12 h比较,两组患者CA 24、48、72 h,SjvO2水平和GCS评分明显升高,而Ca-jvO2水平明显降低,差异均有统计学意义(均P＜ 0.05).两组患者CA 24 h CERO2水平明显高于12h,CA 48、72 hCERO2水平明显低于12h,差异均有统计学意义(均P＜0.05).CA 48、78 h观察组Ca-jvO2、CERO2水平和GCS评分明显高于对照组,而SjvO2水平明显低于对照组,差异均有统计学意义(均P＜0.05).观察组治疗有效率明显高于对照组,而病死率明显低于对照组,差异均有统计学意义(均P＜ 0.05).结论 参附注射液联合亚低温治疗对CA患者心肺复苏心肌组织和脑组织的保护作用明显,能够改善预后.

目的 探讨参附注射液治疗心肺复苏后多器官功能障碍综合征的临床效果.方法 选取心肺复苏后多器官功能障碍综合征患者72例随机分为对照组与观察组,每组36例,对照组接受常规治疗,观察组在对照组基础上应用静脉滴注参附注射液进行辅助治疗.比较两组治疗后24 h和48 h血清肌酸激酶同工酶、神经元特异性烯醇化酶、天冬氨酸氨基转移酶、丙氨酸氨基转移酶、乳酸、白蛋白、血小板计数、总胆红素、肌酐和尿素氮水平,氧合指数,平均动脉压;比较两组治疗后72 h和96 h多器官功能障碍严重程度评分.结果 治疗后24 h和48 h,观察组血清肌酸激酶同工酶、神经元特异性烯醇化酶、天冬氨酸氨基转移酶、丙氨酸氨基转移酶、乳酸、总胆红素、肌酐和尿素氮水平显著低于对照组(P<0.05);观察组氧合指数、平均动脉压、血白蛋白水平显著高于对照组(P<0.05);观察组多器官功能障碍严重程度评分显著低于对照组(P<0.05).结论参附注射液可发挥多器官保护作用,有效治疗心肺复苏后多器官功能障碍综合征.

目的：研究高龄老年脓毒症患者的发病情况及临床特征。方法回顾分析2010年8月至2011年5月我院急诊科入住高龄老年脓毒症病例62例,根据预后分为死亡组(15例)和存活组(47例)，比较两组病例的临床特征。结果高龄老年脓毒症发生率28%(62/223)：病死率24%(15/62)。呼吸道感染所致脓毒症比例高，死亡组与存活组在体温、心率、呼吸、白细胞计数、超敏C反应蛋白的方面比较差异无统计学意义(P>0.05)，但两组数据均高于正常；在血小板计数、血清白蛋白及APACHEⅡ评分方面比较差异有统计学意义(P<001)。死亡组血小板计数、血清白蛋白低于存活组，APACHEⅡ评分高于存活组。结论高龄老年脓毒症在急诊科是一种常见病,患者病情重，病死率高,呼吸道感染所致脓毒症比例高,血小板计数和血清白蛋白降低结合APACHEⅡ评分增高可能与不良预后有关。