有机磷农药中毒并发食管纵隔穿孔1例

A case of organic phosphorus pesticide poisoning complicated with esophageal mediastinal perforation

急性有机磷农药中毒具有毒性大、起病急、病情进展快及并发症多等特点,并发呼吸衰竭、循环衰竭、消化道出血、神经系统损伤并不少见,并发胃穿孔早期亦有相关报道,但合并食管纵隔穿孔却罕见报道。食管纵隔穿孔是一种罕见疾病,一旦发生,可能出现严重并发症,如纵隔感染、纵隔脓肿、胸腔大出血及胸腔感染等,早期诊治对预后至关重要。治疗原则是清除污染源,封闭裂口,恢复食管完整性,控制感染,充分引流,加强营养支持,改善身体状况,促进伤口愈合。本文报道1例有机磷农药中毒并发食管纵隔穿孔,探讨其临床诊疗方法和体会。

Acute organic phosphorus pesticide poisoning is featured by high toxicity,acute onset,rapid progress and multiple complications,etc.It is not uncommon to be complicated with respiratory failure,circulatory failure,gastrointestinal hemorrhage and nervous system damage.Complication with gastric perforation is also reported in the early stage,but complication with esophageal mediastinal perforation is rarely reported.Esophageal mediastinal perforation is a rare disease.Once it happens,it may cause serious complications,such as mediastinal infection,mediastinal abscess,thoracic hemorrhage and thoracic infection.Early diagnosis and treatment are crucial to the prognosis.The treatment principle is to remove the pollution source,seal the fissure,restore the integrity of esophagus,control infection,fully drain,strengthen nutritional support,improve physical condition and promote wound healing.A case of organic phosphorus pesticide poisoning complicated with esophageal mediastinal perforation is reported in this paper,and its clinical diagnosis and treatment method and experience are investigated.