【摘要】：目的:通過選擇我院急診科首診的口服有機磷農藥中毒患者,按照有機磷農藥中毒診療規(guī)范,給予反復洗胃、導瀉清除胃腸道內殘留毒物,阿托品對抗毒蕈堿樣癥狀,氯解磷定恢復膽堿酯酶活力,保護胃粘膜及促進血液內毒物代謝,必要時呼吸機輔助呼吸等綜合治療的基礎上,同時配合應用經皮電刺激足三里穴位治療,觀察臨床導瀉效果及減少嘔吐不良反應的作用,觀察對心、肝等重要臟器的保護和降低不良并發(fā)癥發(fā)生率的作用,觀察治療效果及治愈率,并監(jiān)測操作過程對機體血流動力學的影響及有無暈針、皮膚損傷等不良事件,以評價經皮穴位電刺激足三里對有機磷農藥中毒患者搶救治療作用及其安全性。方法:選擇2013年9月~2014年12月邢臺市人民醫(yī)院急診科首診的口服有機磷農藥中毒患者62例,按照單純隨機抽樣分組原則分為試驗組和對照組各31例,兩組患者均按照有機磷農藥中毒診療規(guī)范給予綜合治療,包括反復洗胃、導瀉清除胃腸道內殘留毒物,阿托品對抗毒蕈堿樣癥狀,氯解磷定恢復膽堿酯酶活力,保護胃粘膜及促進血液內毒物代謝,必要時建立人工氣道、呼吸機輔助呼吸和血液透析治療等。試驗組在洗胃后胃管內注入甘露醇導瀉和藥用炭片吸附毒物前,配合應用經皮電刺激雙側足三里穴位,1次/8h,30min/次,對照組常規(guī)應用導瀉劑和吸附劑。觀察兩組患者首次徹底洗胃后胃管內注入導瀉劑所致的嘔吐發(fā)生率,應用導瀉劑后首次大便時間和排出黑便時間,導瀉期間每日排便次數(shù),達到阿托品化時間及阿托品使用總量,膽堿酯酶活力恢復時間,發(fā)生呼吸衰竭給予氣管插管、呼吸機治療率,觀察血清CK、CK-MB、LDH值3d后變化評估心肝等重要臟器損傷細胞恢復情況,兩組患者住院時間、治愈率和死亡例數(shù),試驗組行經皮穴位電刺激治療前、1min、5min及治療后心率(H)、收縮壓(SBP)、舒張壓(DBP)、平均動脈壓(MBP)及末梢血氧飽和度(Sp O2)變化,并觀察治療過程中有無不良事件如:局部皮膚損傷、肌肉酸痛、暈針等反應發(fā)生,以評價此治療技術的安全性。結果:兩組患者首次徹底洗胃再胃管內注入導瀉劑后的嘔吐情況比較,對照組嘔吐發(fā)生率明顯高于試驗組,兩組比較差異有統(tǒng)計學意義{32.2%(10例)比9.7%(3例),P0.05},兩組患者首次大便時間、首次排出黑便時間比較,試驗組首次排便時間、首次排出黑便時間明顯縮短,兩組比較差異有統(tǒng)計學意義(h:9.3±3.6比11.6±5.2,11.3±5.3比14.5±6.8,均P0.05);導瀉期間排便次數(shù)試驗組多于對照組(次/d:4.3±0.53比3.1±0.41,P0.01);兩組患者達到阿托品化時間、阿托品使用總量和血清膽堿酯酶恢復到正常1/2時間比較,比較差異有統(tǒng)計學意義(h:4.2±2.8比6.6±3.5,mg:66.3±22.8比84.6±24.2,d:6.1±2.4,比8.3±3.9,P0.01);兩組患者呼吸機治療率(13%比35%)和平均住院時間(d:11.3±2.8比13.4±4.2)比較,試驗組優(yōu)于對照組,差異有統(tǒng)計學意義(P0.05);兩組患者治療3d后測定血清CK、CK-MB、LDH值變化比較,試驗組明顯優(yōu)于對照組(u/L:925.1±130.2比1252.1±159.3,28.8±9.1比35.2±12.6,223.9±28.9比315.2±37.4,P0.05);試驗組行經皮穴位電刺激治療前、1min、5min及治療后心率(H)、收縮壓(SBP)、舒張壓(DBP)、平均動脈壓(MBP)及末梢血氧飽和度(Sp O2)變化不明顯,治療后與治療前比較差異無統(tǒng)計學意義{心率(次/min):119.1±8.1、116.2±8.7、120.1±9.1比118.2±10.9,收縮壓(mm Hg,1 mm Hg=0.133 k Pa):118.8±19.1、116.6±16.0、118.8±18.1比115.6±16.8,舒張壓(mm Hg):80.9±15.8、78.5±17.9、77.2±18.2比76.1±17.2,平均動脈壓(mm Hg):96.7±17.5、97.4±18.5、98.0±18.2比95.9±19.5,Sp O2(%):93.3±2.8、94.9±3.2、94.2±3.1比94.2±4.2,均P0.05}。經皮穴位電刺激治療過程中未見局部皮膚損傷、暈針、肌肉酸痛等不良反應發(fā)生,說明此項操作是安全的。結論:1口服有機磷農藥中毒的患者在給予洗胃、導瀉劑及綜合治療的基礎上,采用中西醫(yī)結合治療理論,配合經皮電刺激足三里穴,可降低導瀉劑應用后嘔吐發(fā)生率,增強導瀉效果,促使胃腸道內毒物盡快排出。2有機磷農藥中毒的患者配合經皮電刺激足三里穴治療,可減少住院期間阿托品使用總量,縮短達到阿托品化時間,縮短患者住院時間,促進血清膽堿酯酶活力的恢復,保護心、肝等重要臟器細胞,提高臨床治療效果。3經皮穴位電刺激治療對機體影響小,無不良反應及暈針等意外情況發(fā)生,是安全有效的治療措施,為臨床搶救口服有機磷農藥中毒患者胃腸道毒物盡早、安全的清空和提高臨床療效提供了一種方便、安全、有效的方法。
[Abstract]:Objective: by selecting the patients with orally organophosphorus pesticide poisoning in the first diagnosis of the emergency department of our hospital, according to the diagnosis and treatment of organophosphorus pesticide poisoning, repeated gastric lavage, catharsis to remove the toxic substances in the gastrointestinal tract, atropine to antagonize the muscarinic symptoms, to restore the activity of cholinesterase, protect the gastric mucosa and promote the metabolism of the blood in the blood. On the basis of ventilator assisted breathing and other comprehensive treatment, combined with the application of percutaneous electric stimulation of Zusanli acupoint treatment, the effect of clinical catharsis and the effect of reducing the adverse reaction of vomiting were observed, the protection of important organs such as heart, liver and other important organs were observed and the effect of reducing the incidence of adverse complications was observed, the therapeutic effect and cure rate were observed, and the operation was monitored. The effect and safety of the percutaneous acupoint electrical stimulation of Zusanli on the patients with organophosphorus pesticide poisoning and its safety were evaluated by the influence of the course on the hemodynamics of the body and the safety. Methods: 62 cases of oral organophosphorus pesticide poisoning in the first emergency department of Xingtai People's Hospital in September 2013, December ~2014, were selected. According to the principle of random sampling, 31 cases were divided into the experimental group and the control group. The two groups were given comprehensive treatment according to the diagnosis and treatment of organophosphorus pesticide poisoning, including repeated gastric lavage, catharsis cleaning the residual poison in the gastrointestinal tract, atropine against the symptoms of muscarinic, cholinesterase recovery of cholinesterase activity, the protection of gastric mucosa and the promotion of blood. An artificial airway, ventilator assisted respiration and hemodialysis were established when necessary. The experimental group was injected with mannitol catharsis and Medicinal Charcoal Tablets to adsorb the poison in the gastric tube after gastric lavage, combined with the application of percutaneous electric stimulation of the bilateral Zusanli points, 1 times /8h, 30min/ times, and the control group was routinely used for catharsis and adsorbents. The two groups were observed. The incidence of vomiting caused by catheterization was injected into the gastric tube after the first thorough gastric lavage. The time of first stool after catharsis and the time of excreting the black stool, the number of daily defecation times during the catharsis, atropine time and the total amount of atropine, the recovery time of cholinesterase activity, tracheal intubation and ventilator therapy for respiratory failure were given. Rate, observe the changes of serum CK, CK-MB, LDH value after 3D to evaluate the recovery of important organ damage cells, the time of hospitalization, the cure rate and the number of deaths in the two groups. Before the percutaneous acupoint electrical stimulation, 1min, 5min and the heart rate (H), systolic pressure (SBP), diastolic pressure (DBP), mean arterial pressure (MBP) and peripheral oxygen saturation (Sp O2) were performed in the experimental group. Change, and observe whether there are adverse events in the treatment process, such as local skin injury, muscle soreness, and needle sickness, to evaluate the safety of the treatment technology. Results: the vomiting of the two groups of patients after the first thorough gastric lavage and gastric canal injection of cathartic agent, the incidence of vomiting in the control group was significantly higher than that in the experimental group, the two groups were more different than the experimental group. There were statistically significant {32.2% (10 cases) compared with 9.7% (3 cases), P0.05}, two group for the first time of defecation, the first excretion time of the test group, the first defecation time, the first discharge of the black stool time obviously shortened, the two groups were statistically significant (h:9.3 + 3.6 to 11.6 + 5.2,11.3 + 5.3 ratio 14.5 + 6.8, P0.05); the times of defecation during the cathartic period test The test group was more than the control group (/d:4.3 + 0.53 / 3.1 + 0.41, P0.01); the two groups reached atropine time, the total amount of atropine and the recovery of serum cholinesterase to the normal 1/2 time, the difference was statistically significant (h:4.2 + 2.8, 6.6 + 3.5, mg:66.3 22.8, 84.6 + 24.2, d:6.1 + 0.41, P0.01); The rate of treatment (13% to 35%) and the average time of hospitalization (d:11.3 + 2.8 13.4 + 4.2) were better than those in the control group. The difference was statistically significant (P0.05). The changes of serum CK, CK-MB, LDH values in the two groups were significantly better than those in the control group (u/L: 925.1 + 130.2 compared with 1252.1 + 159.3,28.8 + 9.1 / 9.1 / 35.2 + 12.6223.9 + 28.9) 315.2 Before the treatment of percutaneous acupoint electrical stimulation, 1min, 5min and heart rate (H), systolic pressure (SBP), diastolic pressure (DBP), mean arterial pressure (MBP) and terminal blood oxygen saturation (Sp O2) were not significant before treatment. The difference was not statistically significant {heart rate (secondary /min) before treatment: 119.1 + 8.1116.2 + 8.7120.1 + 9.1 to 118.2 + 10.9 after treatment. Systolic pressure (mm Hg, 1 mm Hg=0.133 K Pa): 118.8 + 19.1116.6 + 16.0118.8 + 18.1 / 115.6 + 16.8, diastolic pressure (mm Hg): 80.9 + 15.8,78.5 + 18.2 ratio 76.1 + 17.2, average arterial pressure (96.7 +% + 18.2 ratio 95.9 + 19.5,%) There is no local skin injury, acupuncture, muscle pain and other adverse reactions in the process of irritation. Conclusion: 1 patients with orally organophosphorus pesticide poisoning are treated by combination of traditional Chinese and Western Medicine on the basis of gastric lavage, catharsis and comprehensive treatment, combined with percutaneous electric stimulation of the Zusanli point, which can reduce catharsis The incidence of postoperative vomiting, enhancing the effect of catharsis, prompting the gastrointestinal toxicants to expel.2 organophosphorus pesticide poisoning as soon as possible combined with the percutaneous electric stimulation of Zusanli, can reduce the total amount of atropine during hospitalization, shorten the atropine time, shorten the patient's hospitalization time, promote the recovery of serum cholinesterase activity, and protect the recovery of the serum cholinesterase activity. Heart, liver and other important organ cells to improve the effect of clinical treatment..3 percutaneous acupoint electric stimulation therapy has little influence on the body, no adverse reaction and acupuncture. It is a safe and effective treatment measure. It provides a safe and effective treatment for patients with oral organophosphorus pesticide poisoning. Convenient, safe and effective method.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R595.4

【相似文獻】

相關期刊論文 前10條

1 徐曉;方劍喬;張奕;劉侃卓;;經皮穴位電刺激治療粘連前期肩周炎臨床觀察[J];上海針灸雜志;2006年07期

2 張嶸;;一種標準化的經皮穴位電刺激方法用于解除吸煙者的煙癮[J];生理科學進展;2009年02期

3 盛明山;;經皮穴位電刺激治療周圍性面神經麻痹[J];上海針灸雜志;1996年S1期

4 胡興國;經皮穴位電刺激強度對術后鎮(zhèn)痛需求的影響[J];國外醫(yī)學.麻醉學與復蘇分冊;1998年06期

5 米慧;鞏愛玲;孫偉;馮雪花;李玉;;經皮穴位電刺激治療卵巢低反應30例療效觀察[J];山東中醫(yī)藥大學學報;2013年06期

6 劉侃卓;;經皮穴位電刺激治療粘連前期和粘連期肩周炎89例[J];上海針灸雜志;2007年05期

7 葛建強;張宏;;經皮穴位電刺激聯(lián)合提肛運動治療慢性Ⅲ型前列腺炎60例[J];陜西中醫(yī);2009年01期

8 朱丹華;童基均;潘敏;陳裕泉;陳華德;;經皮穴位電刺激鎮(zhèn)痛的腦電研究[J];浙江大學學報(工學版);2009年12期

9 張磊;羅芳;李歡冬;王保國;劉曉媛;;丘腦在經皮穴位電刺激鎮(zhèn)痛效果中的作用[J];中國康復理論與實踐;2011年11期

10 鄧林;楊小成;鄧田;湯偉;陳訪;;經皮穴位電刺激對婦科腹腔鏡術后惡心嘔吐的影響[J];中國中醫(yī)急癥;2013年06期

相關會議論文 前10條

1 王均爐;任秋生;沈財成;謝文霞;鄭瑞獻;倪劍武;;經皮穴位電刺激對開顱術圍術期腦損傷相關因子的影響[A];2007年浙江省麻醉學學術年會論文匯編[C];2007年

2 王均爐;任秋生;沈財成;謝文霞;鄭瑞獻;倪劍武;;經皮穴位電刺激對開顱術圍術期腦損傷相關因子的影響[A];第九屆全國針刺麻醉針刺鎮(zhèn)痛及針刺調整效應學術研討會論文集[C];2007年

3 唐巖峰;;經皮穴位電刺激對婦科腹腔鏡術后惡心嘔吐的防治作用[A];2009年浙江省麻醉學學術會議論文匯編[C];2009年

4 謝文霞;王均爐;趙紅琴;李利紅;吳晶;孟軼男;;經皮穴位電刺激防治術后鎮(zhèn)痛尿潴留的療效評價[A];2011浙江省針灸學會年會暨學術交流會論文匯編[C];2011年

5 鄭娟麗;洪霞;沈鋒;崔q輝;;經皮穴位電刺激對腰麻下痔瘺術后尿潴留的影響[A];2013年浙江省肛腸外科學術年會暨結直腸疾病的微創(chuàng)及綜合治療新進展學習班論文匯編[C];2013年

6 王均爐;任秋生;;經皮穴位電刺激對顱腦手術圍術期腦氧腦糖代謝的影響[A];2007年浙江省麻醉學學術年會論文匯編[C];2007年

7 王均爐;任秋生;謝文霞;;經皮穴位電刺激對顱腦手術圍術期腦氧腦糖代謝的影響[A];第九屆全國針刺麻醉針刺鎮(zhèn)痛及針刺調整效應學術研討會論文集[C];2007年

8 吳鎏楨;閻俊娟;韓濟生;;2/100Hz經皮穴位電刺激對27例青少年網絡成癮癥的治療作用[A];第九屆全國針刺麻醉針刺鎮(zhèn)痛及針刺調整效應學術研討會論文集[C];2007年

9 陳明顯;葉開升;金曼;蔡淦;;經皮穴位電刺激法治療腹瀉型腸易激綜合征的隨機對照臨床研究[A];第三屆江浙滬中西醫(yī)結合高峰論壇論文匯編[C];2011年

10 金曼;葉開升;陳明顯;胡萍;王芹;盧躍棣;葉育雙;;經皮穴位電刺激法治療腹瀉型腸易激綜合征的生活質量研究[A];第二十四屆全國中西醫(yī)結合消化系統(tǒng)疾病學術會議專題報告及論文集[C];2012年

相關重要報紙文章 前2條

1 郭永紅 石田寅夫;可推廣經皮穴位電刺激治療DPN[N];中國醫(yī)藥報;2005年

2 ;經皮穴位電刺激治肩周炎[N];中國中醫(yī)藥報;2009年

相關博士學位論文 前1條

1 張玲;視網膜脫離患者生存質量及經皮穴位電刺激輔助手術鎮(zhèn)痛的臨床研究[D];成都中醫(yī)藥大學;2010年

相關碩士學位論文 前10條

1 趙秋燕;術前經皮穴位電刺激改善婦科腹腔鏡手術患者術后恢復質量[D];福建醫(yī)科大學;2015年

2 高輝;經皮電刺激足三里穴在有機磷農藥中毒患者搶救中的作用及安全性研究[D];河北醫(yī)科大學;2015年

3 于晗;經皮穴位電刺激與針刺療法治療功能性消化不良的臨床比較觀察[D];南京中醫(yī)藥大學;2015年

4 朱同常;經皮穴位電刺激治療慢性非細菌性前列腺炎合并精液不液化療效觀察[D];安徽中醫(yī)藥大學;2015年

5 范圣華;經皮穴位電刺激對2型糖尿病糖代謝障礙作用的研究[D];中國中醫(yī)科學院;2015年

6 陳琛;經皮穴位電刺激干預對卵巢低反應患者妊娠結局影響的臨床研究[D];山東中醫(yī)藥大學;2011年

7 孫玉;基于腦電非線性動力學分析的中醫(yī)針刺療法和經皮穴位電刺激療法研究[D];浙江大學;2007年

8 陳琛;經皮穴位電刺激對“五七”腎虛婦女卵細胞質量與β-內啡肽的影響[D];山東中醫(yī)藥大學;2014年

9 馬福國;經皮穴位電刺激對呼氣末七氟烷濃度及應激反應的影響[D];青島大學;2009年

10 司俊麗;經皮穴位電刺激結合靶控輸注技術在乳腺手術麻醉中效能評價的臨床研究[D];廣州中醫(yī)藥大學;2010年

，

本文編號：2167596