重度有机磷农药中毒抢救失败的临床反思

Clinic introspection of patients with severity organophosphorous insecticides intoxication failed to rescue

目的 探讨重度有机磷农药中毒抢救失败病例中的误治问题及其产生原因。方法 回顾性分析 7例重度有机磷农药中毒抢救失败病例的病历资料 ,总结其中存在的误治问题并分析其产生原因。结果 重度有机磷农药中毒抢救中的误治主要表现为清除毒物不彻底 ;阿托品剂量应用或停药时间不当 ;胆碱酯酶复能剂使用途径不当 ;治疗过程中误用了一些抑制胆碱酯酶活性的药物 ;呼吸衰竭病人机械通气方法不当。其产生的主要原因包括对病人病情的判断错误 ;医生对某些影响重度有机磷中毒抢救疗效的相关因素缺乏深入了解。结论 正确判断病情是减少重度有机磷中毒抢救中误治发生率的关键。

Objective To explore erroneous treatments and causes of failing to rescue patients with severity organophosphorous insecticides intoxication.Methods Retrospective methods were used to analyze medical record data of 7 patients with severity organophosphorous insecticides intoxication.Points of erroneous treatment on them were summed up and the causes were analyzed.Results Points of erroneous treatment on patients with severity organophosphorous insecticides intoxication included the following:①poison weren't clear away completely;②injection dose and call off opportunity were wrong;③giving channel of Pralidoxime iodide was wrong;④Some of drug inhibiting cholinesterase(ChE) activity were be used during therapy severity organophosphorous insecticides intoxication;⑤some of methods on mechanical ventilation to patients with respiratory failure were wrong. Causes of producting these erroneous treatment points included: ①patients' condition was evaluated erroneously;②some physicians were short of comprehend to some factors affecting curative effect of severity organophosphorous insecticides intoxication. Clinic introspection of patients with severity organophosphorous insecticides intoxication failed to rescue$$$$ YANG Jing,MENG Xin-ke.Emergency Department of Shenzhen Second Hospital,Shenzhen 518035,China Abstract Objective To explore erroneous treatments and causes of failing to rescue patients with severity organophosphorous insecticides intoxication.Methods Retrospective methods were used to analyze medical record data of 7 patients with severity organophosphorous insecticides intoxication.Points of erroneous treatment on them were summed up and the causes were analyzed.Results Points of erroneous treatment on patients with severity organophosphorous insecticides intoxication included the following:①poison weren't clear away completely;②injection dose and call off opportunity were wrong;③giving channel of Pralidoxime iodide was wrong;④Some of drug inhibiting cholinesterase(ChE) activity were be used during therapy severity organophosphorous insecticides intoxication;⑤some of methods on mechanical ventilation to patients with respiratory failure were wrong. Causes of producting these erroneous treatment points included: ①patients' condition was evaluated erroneously;②some physicians were short of comprehend to some factors affecting curative effect of severity organophosphorous insecticides intoxication. [WT5'HZ Conclusion It is the key factor to raise rate of rescuing severity organophosphorous insecticides intoxication successfully that physician distinguish patients'condition correctly.