6例虫螨腈中毒患者集束化急救护理的效果观察

Effect of cluster emergency nursing for 6 patients with chlorfenapyr poisoning

目的观察集束化急救护理对虫螨腈中毒患者的疗效。方法回顾性分析6例虫螨腈中毒患者的救治及护理过程。结果6例虫螨腈中毒患者中,口服中毒5例,呼吸道及皮肤吸收毒物中毒1例。6例虫螨腈中毒患者均启动中毒救治绿色通道,开展多学科合作集束化治疗护理及毒物检测;1例毒物检测未检出虫螨腈成分,予以排除;余5例患者在初期均有不同程度的发热、乏力、恶心呕吐等症状,其中4例患者病程后期出现高热,意识障碍程度加重,在中毒后2~11 d治疗无效死亡(其中1例失联,预计死亡),病死率达80%。结论虫螨腈中毒无特效解毒剂,病死率极高;中毒后尽快留取患者血液、尿液等标本进行毒检,同时给予早期洗胃(6 h内)、肠道吸附、胃肠道导泄、灌肠等对症治疗,尽早行连续血液净化清除血液毒素,有条件者可行体外膜肺氧合治疗。

Objective To observe the effect of cluster emergency nursing in treating patients with chlorfenapyr poisoning.Methods A retrospective analysis was performed for the treatment and nursing processes of 6 patients with chlorfenapyr poisoning.Results Among the 6 patients with chlorfenapyr poisoning,5 cases were orally poisoned and one case was poisoned by respiratory tract and skin absorption of toxins.All of the 6 patients with chlorfenapyr poisoning were treated through the green channel for poisoning treatment,and multidisciplinary cooperation cluster treatment and nursing as well as toxicant detection were carried out.One patient was excluded because no chlorfenapyr component was detected in the toxicant detection;the remaining 5 patients had different degrees of fever,fatigue,nausea and vomiting and other symptoms in the early stage,and among them,4 patients had high fever and aggravated degree of consciousness disturbance in the later stage of the disease,and died of ineffective treatment for 2 to 11 days after poisoning(one patient was out of contact and was expected to die),with a mortality rate of 80%.Conclusion There is no specific antidote for chlorfenapyr poisoning,and the mortality rate is extremely high.After poisoning,blood,urine and other specimens should be collected as soon as possible for toxic examination.At the same time,early gastric lavage(within 6 hours),intestinal adsorption,gastrointestinal catharsis,enema and other symptomatic treatments should be given.Continuous blood purification should be performed as soon as possible to remove blood toxins,and extracorporeal membrane oxygenation can be performed if conditions permit.