Chlorfenapyr is a liposoluble insecticide belonging to the pyrrole family.Chlorfenapyr is activated when the N-ethoxymethyl side chain breaks,forming a toxic metabolite,which uncouples oxidative phosphorylation in the mitochondria,inhibits the production of adenosine triphosphate(ATP),and leads to the death of cells and target organisms.[1]Symptoms of chlorfenapyr poisoning in patients are mild and atypical in the early stage,especially in patients receiving low dose exposure;however,such cases are rare and may be ignored by physicians,often leading to delayed treatment.[2,3]Once the hypothalamus thermoregulatory center and medulla oblongata respiratory and heartbeat centers are involved,patients often develop hyperthermic coma,leading to death.

Background The objective of this study was to examine the relationship of mental health status between self-poisoning suicide patients and their family members, and it also sought to identify potential patient’s risk and parental factors for the prediction of suicide attempt, anxiety, and depression. Methods In this study, 151 poisoned patients were prospectively included, and they were matched 1:1 with 151 family members. We gathered information on patient’s and their matched family member’s demographics, lifestyle choices, mental health status, level of intimacy, and history of psychiatry disease. The relationship of patient’s and their family member’s mental health state was investigated using a correlation matrix. Multivariable analyses (multiple logistic regression) were conducted among patients and their matched family members, to identify potential risk factors for self-poisoning suicide, anxiety, and depression. Results Of the total patients, 67.55% (102/151) attempted self-poisoning suicide. Poisoned patients had more severe anxiety and depression symptoms than their matched family members, and this difference was even more pronounced among patients with self-poisoning suicide. Generalized anxiety disorder-7 (GAD-7) score for family members was significantly and favorably correlated with patient’s GAD-7 score after eliminating non-suicide patients and their matched family members. The patient health questionnaire-9 (PHQ-9) score showed a similar pattern, and the family member’s PHQ-9 score was strongly and favorably associated with patient’s PHQ-9 and Beck hopelessness scale-20 (BHS-20) score. Multivariable analysis showed that married marital status ( P = 0.038), quitting smoking ( P = 0.003), sedentary time of 1 to 6 h ( P = 0.013), and participation in a sports more than five times per week ( P = 0.046) were all significantly associated with a lower risk of suicide by self-poisoning, while a more serious anxiety state ( P = 0.001) was significantly associated with a higher risk of self-poisoning suicide. Multivariable analysis demonstrated that, specifically among self-poisoning suicide patients, married marital status ( P = 0.011) and no history of psychiatry disease ( P < 0.001) were protective factors for anxiety, while divorced or widowed marital status ( P = 0.004), a sedentary time of 1 to 3 h ( P = 0.022), and a higher monthly income ( P = 0.027) were significant contributors to anxiety. The propensity of additional family-matched characteristics to predict patient’s suicidality, anxiety, and depression was also examined. Conclusions Self-poisoning suicide patients have severe mental health issues. Patients who self-poison have a close connection to their family member’s mental health, particularly their levels of anxiety and depression. According to the findings, being married and adopting healthy lifestyle habits, such as quitting smoking and drinking, increasing their physical activity levels, and managing their idle time, are able to help patients with mental health concerns and even suicidal thoughts.

Colchicine is a neutral lipophilic tricyclic alkaloid toxic to human cells containing tubulin,[1-2] and primarily stops the proliferation of active cells in the mitotic metaphase, such as intestinal mucosal cells and hematopoietic cells. It is widely used in treating gout and familial Mediterranean fever, while it is also used in establishing animal and plant experimental model.[3] In the recent study, treatment of patients affected by coronavirus disease 2019 (COVID-19) with colchicine may prove a viable path.[4] The course of colchicine poisoning can be divided into three stages,[5] and most of the patients died in the second stage (2–7 d, the multiple organ injury stage). The cause of death was heart failure [6] and bone marrow hematopoietic failure in the terminal phase.[7] Hematopoiesis is a classic sign of colchicine poisoning. Many cases of colchicine poisoning have been comprehensively reported, and the target organs included heart, digestive tract, muscle, lung, kidney, hematopoietic system, etc.[8-11] This study aimed to investigate the injury of bone marrow hematopoietic system after colchicine poisoning and evaluate the therapeutic effect of bone marrow hematopoietic stimulation drugs.

双硫仑(disulfiran)样反应又称戒酒硫样反应,作用机制与双硫仑反应机制类似,主要是特定药物因分子结构中含特殊基团与乙醇相互作用而抑制乙醇的代谢,导致人体乙醛增多和儿茶酚胺类物质减少引起的临床症状[1].近年来,服用头孢类药物期间或前后饮酒而出现双硫仑样反应的报道较多,未见服用治疗肩周炎药物后饮酒引起双硫仑样反应的报道.解放军总医院第五医学中心南院区中毒救治中心于2019年1月31日成功救治1例口服肩周炎药物饮酒后引起酒精中毒伴双硫仑样反应的患者,现将救治与护理过程汇报如下.

目的 探讨经皮扩张气管切开术(PDT)在中毒危重症患者中的应用价值.方法 对2015年1月-2018年8月解放军总医院第五医学中心中毒救治科20例中毒危重患者行PDT治疗的临床资料进行回顾性分析.结果 20例患者手术成功,出血量少,操作时间短,住院期间无导管脱位、皮下气肿、纵隔气肿等并发症,1例患者并发切口感染,回访2例患者出现气管前壁肉芽组织过度生长致气管狭窄.结论 PDT是一项可在中毒救治ICU床旁实施的微创技术,由中毒救治ICU医师独立完成,预计短期内不能拔除气管的中毒患者及神志不清者应尽早行PDT.

Objective To explore the safety management of pickup and transportation of acute severe poisoning patients (ASP) by medical rescue helicopters. Methods For the task of pickup and transportation of six ASPs,we quickly started an emergency rescue plans including establishing a rescue team, preparing for first-aid medicine and equipment, preparing for intensive care unit in Poisoning Treatment Center, completing safety management carefully before and during the pickup and transportation such as logistic service,environmental safety,timely diagnosis,cooperation in different departments and handover of patients'information.Results Six ASPs were picked up and transported smoothly without any accidents. The average length of stay was 55.5 days. Two patients were discharged with good outcome but two patients with critical condition were discharged without any rescue or treatment under the will of family members and two died. Conclusion A detailed plan plays an important role in the safety management of pickup and transportation of ASPs. Great importance attached by leaders of the hospital, coordination and cooperation of different departments and a well-trained, professional rescue team for emergency transport and poisoning treatment contribute to the success of pickup and transportation.

Objective To explore the management process of medical rescue helicopter to transport critical patients to hospital tempo?rary parking apron safely and smoothly.Methods According to the characteristics of the medical rescue helicopter and safety management re?quirements of the special environment of the hospital temporary apron,to design the nursing safety management process in pick-up and trans?portation.Results Six critical patients were picked-up and transported safely and smoothly,without emergency or accident.The average hos?pitalization was 52 days.The three patients were treated well and discharged safely.One patient was in critical condition and the family urged to stop all rescue and abandon treatment. Two patients died from emergency treatment.Conclusion Scientific and normative rescue proce?dures and strict implementation and close cooperation between the unified command and departments are the key to ensure the safety of transit care for patients with critical diseases.

Objective To summarize the clinical characteristics and therapeutic effect of second-generation anticoagulant rodenticide poisoning,so as to improve the understanding and diagnosis and treatment of this disease.Methods We retrospectively analyzed 71 misdiagnosed cases with anticoagulant rodenticide poisoning,admitted to Poisoning Treatment Center of the Army during December 2013 and September 2016,including the general situation,the cause of poisoning,poisoning time,clinical manifestation,hemoglobin and blood coagulation function,poison detection,diagnosis,prognosis and so on.Results 71 patients with anticoagulant rodenticide poisoning comprised 44 males and 27 females with an average age of 40 years (15 to 79).The average poisoning time was 12 days,and the average hospitalization time was 12 days.10 patients were mild poisoning,24 patients were moderate poisoning,and 37 patients were severe poisoning.The index of blood coagulation function was significantly better than that of admission,which was statistically significant.The average amount of vitamin K1 intake was 60 mg/d,the dosage was 10 mg/d after discharge,the average vitamin K1 time of withdrawal was 3 months after discharge,and the average concentration of anticoagulant rodenticide was 11 ng/mL when vitamin K1 was stopped.42 patients required discharge,and the other 29 cases were discharged after improvement.Hematuria,gingival bleeding (oral),and (ear) nasal bleeding were the main symptoms of the disease.There were significant differences in the gender,the causes of poisoning,and the indexes of blood coagulation (PT,APTT,activity).There was a significant correlation between the time of poisoning and the function of blood coagulation and the amount of poison.There was a correlation between the amount of vitamin K1 and the indexes of blood coagulation function,hemoglobin and poison.Vitamin K1 withdrawal time was correlated with the amount of toxicant,which was statistically significant.2 patients did not use vitamin K1 after discharge,and died.Conclusion The patients with unexplained hematuria,(mouth) bleeding gums,(ears) nasal bleeding and other symptoms should be considered anticoagulant rodenticide poisoning.Vitamin K1 is a specific antagonist of anticoagulant rodenticide poisoning.The dosage of vitamin K1 and the time of drug use are positively correlated with the concentration of toxin and prothrombin time,but negatively correlated with prothrombin activity and hemoglobin.The treatment should be based on coagulation function and the concentration of anticoagulant rodenticide gradually adjust the amount of vitamin K1,timely supplement of red blood cells.

百草枯是一种广谱除草剂，毒力强，毒性长，经消化道、呼吸道和皮肤吸收后，迅速分布于全身，对心、肝、肾、肺等多器官有较强的损害，尤以肺脏受损最为严重，通常肺纤维化发生在中毒后5～9天，2～3周达到高峰，最终可因弥漫性肺纤维化导致呼吸衰竭死亡[1]。目前缺乏特效解毒剂，急性百草枯中毒死亡率可高达60％～80％[2]。2014年1月我科收治1例急性重度口服百草枯中毒的患者，病情危重，出现并发症多，经积极救治和精心护理，为后续的肺移植术争取了宝贵的时间和良好的身体条件。现将早期救治护理体会总结如下。

1临床资料<br>　　患者，女性，63岁，主因口服药物中毒后意识不清11 h入院。入院时患者处于昏迷状态，胸片提示右肺炎症；实验室检查结果：肌酸激酶9971 U／L、C反应蛋白32 mg／L；毒理学检查结果：血液中喹硫平、艾司唑仑浓度分别为5．3、1．1μg／ml。患者右后侧臀部有8 cm ×10 cm大小Ⅰ期压疮，破溃处有少许渗出，渗出液清亮。入院后行气管插管开放气道，给予血液灌流清除毒物、抗感染、抑酸、保肝、营养神经、补液，压疮处每日换药等治疗，患者病情逐渐好转。治疗期间为避免压疮部位再次受压，多予患者左侧卧位。入院第2日患者意识转清醒，自主呼吸力量好，予拔除气管插管。第3日患者出现高热、寒战，体温最高38．5℃，予退热、调整抗生素、拔除右侧股静脉置管（当时考虑不除外深静脉置管感染可能），效果不佳。第4日行胸腹部CT检查示两肺炎性病变，双侧胸腔少量积液，左肺较大面积炎性渗出并局部支气管堵塞征。治疗上给予加强吸痰、雾化吸入化痰，根据痰培养结果调整抗生素，护理上给予调整患者卧床体位为平卧位或偏右侧卧位，经积极处理后患者可排出较多黄白色黏痰。第6日压疮处加重，表面有结痂及脓性附着，周围有红肿，压之不褪色。第8日、13日复查胸部CT均提示左肺病变范围逐步缩小，胸腔积液逐渐减少。患者可自行床上活动，多给予半坐卧位，多偏左侧坐位，叩背。压疮部位定时清洁换药，去除溃疡坏死组织，涂抹药膏，压疮亦逐渐好转。经过精心的治疗和护理，第19日患者出院，出院时压疮痊愈，肺炎基本吸收。

稀料是一种含有苯、氯乙烷、正乙烷等成分的有机溶剂，经呼吸道、皮肤、消化道吸收可造成人体中毒，国内报道口服稀料中毒病例不少，但口服大量稀料中毒致腹泻引起化学性烧伤病例罕见，现将我院救治的1例报告如下。

百草枯（paraquat，PQ），化学名1-1-二甲基-4-4-联吡啶二氯化物，化学组成为C12H14N2Cl2，分子量为257.3，属有机氮类接触性除草剂。自1962年开始作为除草剂应用于农业生产之后，迅速在全球范围内广泛使用。常用制剂为20％水溶液，正确使用比较安全，但若人畜口服，中毒病死率较高，腐蚀性较强，近30年来中毒人数呈上升趋势。现就百草枯中毒患者的救治和护理做一综述。