急性重度有机磷农药中毒并发呼吸衰竭的救治分析

Analysis on the treatment of acute severe organophosphorus pesticide poisoning complicated with respiratory failure

目的对急性重度有机磷农药中毒并发呼吸衰竭的救治进行分析探讨。方法选择南京市中西医结合医院急诊重症监护治疗病房2016年1月—2019年11月收治的经急诊抢救室转入的急性重度有机磷农药中毒并发呼吸衰竭患者16例。患者采取小胃管洗胃,胆碱受体拮抗药和胆碱酯酶复能剂的及时使用,呼吸衰竭者行气管插管机械通气,预防肺部感染、应激性溃疡、中间型综合征等并发症,有血液灌流适应证者尽早血液灌流治疗等综合救治措施,总结经验,让更多患者获益。结果通过因人施治、注重细节、综合救治,16例患者中,11例经治疗后治愈出院,住院时间最长29 d,最短2 d,平均住院17 d。结论及时有效彻底清除胃肠道毒物,及时气管插管、规范使用呼吸机辅助呼吸,早期、足量、合理应用抗胆碱药,对症及支持治疗等综合措施都是成功救治的重要环节,供相关学者参考。

Objective To analyze and discuss the treatment of acute severe organophosphorus pesticide poisoning complicated with respiratory failure.Methods A total of 16 cases of acute and severe organophosphorus pesticide poisoning patients with respiratory failure who were admitted to the Emergency Intensive Care Ward of Nanjing Integrated Traditional Chinese and Western Medicine Hospital from January 2016 to November 2019 and transferred to the emergency room.The recommendations of comprehensive treatments were provided based on use of gastric lavage,timely application of cholinoceptor blocking drugs and cholinesterase reactivators,use of tracheal intubation for patients with respiratory failure,prevention of pulmonary infections,intermediate syndrome and other complications,timely hemoperfusion therapy.Results The treatments were detailed,integrated and given to patients in accordance with their conditions.Among the total of 16 patients,11 patients of them were cured and discharged.The duration of hospital stays ranged from 2 to 29 days with an average of 17 days.Conclusion The timely and effective removal of gastrointestinal poisons,timely performance of tracheal intubation,standardized use of ventilator to assist breathing,early,adequate and reasonable application of anticholinergics,symptomatic and comprehensive measures such as supportive treatment,are all important parts of successful treatments for reference by relevant scholars.