急性有机磷农药中毒的护理查房文档资料.ppt
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1、病例介绍 伍南臻,患者,周桂云,女性,46岁入院时间:2011-08-07主诉:呕吐、口吐白沫、神志不清、大小便失禁4小时,Patients,guiyun Zhou,female,46years old Admission time:2011-08-07Chief Complaint:vomiting,foaming at the mouth,confusion,incontinence 4 hours,基本资料,1,病例介绍,现病史:患者于4小时前因争吵后自服农药(半硫磷)约100ML,服用后出现神志改变。,History of present illness,For four hours
2、after an argument with his family before,She take the pesticide about 100Milliliters,Pesticides considered for the half sulphur phosphoric.After take appear mind change.,病例介绍,家人行紧急救治后送入当地医院行洗胃治疗,于2011-08-07 12:20急诊平车转入我院肾病内科,Patients after medication with vomiting,after the emergency salvage,she was
3、 send to the local hospital for gastric lavage for her famliy.In august 7,2011 12:20,She was transferred to our hospital nephropathy internal medicine with emergency flatcar.,病例介绍,转运途中出现呕吐,大小便失禁症状。门诊以“急性有机磷农药中毒”收治。起病以来,精神差,体重无明显变化。,In transit,Patients had repeated vomiting and Elimination of urine a
4、nd feces are not controlled by herself,Clinic diagnosis is AOPP,After the patient is admitted to hospital,her Spirit was so bad and weight did not have significantly change.,病例介绍,既往有肺脓肿病史,已行部分肺叶切除术,术中有输血,有青霉素过敏史。,she had lung abscess before,and was done a partial lobectomy,in that operation,She had
5、a blood transfusion.The most important is she had the Penicillin allergy.,病例介绍 全凤春,体格检查:T35.8 P126次/分 R20次/分 BP109/69mmHg,Physical examination:Temperature:35.8,Pulse:126 Beat Per Minute,respiration:20 Beat Per Minute,Blood Press 109/69mmHg,病例介绍,神志浅昏迷,双侧瞳孔等大等圆3mm,对光反射迟钝,口唇发绀,皮肤湿冷,双肺呼吸音粗,可闻及大量湿性啰音。,Co
6、ma consciousness,Pupils are equal roundness and same size with 3mm,reaction to light shows delay,while the lips is cyanotic,Breath sound shows Coarse while it Can be heard and a lot of wet rales.,病例介绍,心率 126次/分,肠鸣音活跃,四肢肌张力稍高,无自主活动,病理反射未引出。,Heart rate is 126Beat Per Minute,borhorygmus shows increased
7、,Limb muscle tone is slightly higher,there is no independent activity,Pathological reflex is not elicited.,病例介绍 刘伟明,入院诊断:1、急性重症农药中毒(半硫磷)2、中毒性心肌炎 3、吸入性肺炎,Admission diagnosis:1、severe acute pesticide poisoning(half sulphur phosphorous)2、toxic myocarditis 3、aspiration pneumonia,主要病情变化 马志群,8-8 01:40T39.
8、1摄氏度,予温水擦浴 05:20 患者开始出现躁动,予丙泊酚5毫升IV 效果不明显,予地西泮镇静,One forty on august 8th,the patients body temperature rises to thirty-one point one degrees celsius,we give him a warm water bath.Five twenty,the patient begin to appear restless,propoful five milliliter intravenens injection,the effect is not obvious
9、,to the diazepam sedation.,病例介绍,12:30 患者躁动不安,血氧饱和度波动在70%-80%请麻醉科及ICU会诊后考虑气管插管脱出予重新插管14:50 患者转入ICU,Twelve thirty,the patient is restless,fluctuations of oxygen satturation in seventy percent to eighty percent.then please anesthesia and intensive care unit consulation,considering the endotracheal to b
10、e extrusion,to reintubation for him.Fourteen fifty,the patient is transforred to the intensive care unit,病例介绍 贺 舒,转入ICU时情况:体温37.3,脉搏140次/分,呼吸35次/分,血压116/87mmHg,血氧饱和度95%,When transferred to ICU conditions:temperature 37.3,pulse 140 beats/min,breathing 35 times/min,blood pressure 116/87mmHg,oxygen sat
11、uration 95%.,病例介绍,神志镇静中,躁动不安,两侧瞳孔等大等圆4mm,对光反射迟钝,气管插管,呼吸机辅 助呼吸,气道内少量痰液,皮肤干燥。,conscious sedation,irritability,Pupils are equal roundness and same size with 4mm,reaction to light shows delay,endotracheal intubation,mechanical ventilation,Within a few airway sputum,dry skin.,病例介绍,双肺可闻及中等量湿性啰音,腹部叩诊呈鼓音,诊断
12、为:1.急性有机磷农药中毒;2.吸入性肺炎、1型呼吸衰竭;3.中毒性心肌炎。,double-lung can be heard and moderate moist rales,The drum sound abdominal sound The diagnosis is:1:acute organophosphorus pesticide poisoning;2:aspiration pneumonia,type 1 respiratory failure;3:toxic myocarditis.,病例介绍,予以呼吸机辅助呼吸,留置胃管,胃肠减压,留置深静脉导管,遵医嘱予抗感染、护胃、护心、
13、解毒、导泻等对症支持治疗。,To mechanical ventilation,indwelling stomach tube,decompression,indwelling venous catheters,prescribed to fight infection,protect stomach mucosa,protection of heart function,detoxification,catharsis,symptomatic and supportive treatment.,病例介绍 苏敏,现患者的情况:神志模糊,躁动不安,双侧瞳孔等大瞪圆3mm,对光反射迟钝,皮肤干燥。
14、,The current situation of patients:mind fuzzy,restless,Pupils are equal roundness and same size with 4mm,reaction to light shows delay,the skin is dry.,病例介绍,有发热,最高体温39,予物理降温。血压稳定,仍给予阿托品间断静推。,with fever,the maximum temperature about 39,to the physical cooling.Blood pressure stability,intermittent int
15、ravenous injection of atropine,病例介绍,气道内有少量的黄色痰液,双肺未闻及湿啰音,四肢有自主活动。,there were a few of the airway yellow sputum,double lung not smell and wet go sound,limbs have independent activities.,病例介绍,主要的实验室检查 8-7 WBC 27.3*109/L,CHE 23KU/L,8-8尿常规RBC2-4/HP,K+3.38 mmol/L,钙离子1.73 mmol/L,CHE 10KU/L,心肌酶、肝功能基本正常,The
16、 main laboratory tests On 8-7 The patient s WBC is 27.3*109/L and CHE is 23 KU/L.On 8-8 Form the Routine Examination of Urine on high power lens we can see 2 to 4 red blood cells,The patient s Potassium is 3.38 mmol/L,calcium is 1.73 mmol/L and Cardiac enzyme and liver function are normal.CHE 10.0KU
17、/L,病例介绍,8-9 CHE 8.0 KU/L,。胸片提示:肺部感染及双侧胸膜炎。8-12血常规正常,CHE32 KU/L,On 8-9,CHE 8.0KU/L;Chest X ray tip:lung infection and bilateral pleurisy.On 8-12 Blood routine is normal,and CHE is 32KU/L,病因与发病机制 谢妹娜,病因生产及使用过程的不当:如生产设备密封不严导致化学毒物泄漏;喷洒杀虫药过程中经皮肤和呼吸道吸收,EtiologyImproper production and use:For example,produ
18、ction equipment sealed poorly result in leakage of chemical toxicant;in the process of spraying pesticide,absorbed through skin and airway.,病因与发病机制,生活性中毒:主要由于自服、误服或摄入被污染的水源和实物水果等。,Living poisoning:Mainly due to drinking or eating contaminated water and fruit voluntarily or by mistake etc.,病因与发病机制,有机
19、磷农药中毒机制主要是抑制体内胆碱酯酶的活性。正常情况下,胆碱能神经兴奋所释放的递质乙酰胆碱被胆碱酯酶水解为乙酸及胆碱而失去活性。,Mechanism of poisoningThe Primary mechanism of organophosphate pesticide poisoning is inhibition of the action of cholinesterase in body.In general,excitement of cholinergic nerve releases neurotransmitter-acetylcholine which can be hy
20、drolyzed to choline and acetic acid by cholinesterase and lose its activity.,病因与发病机制,有机磷农药进入人体后与体内胆碱酯酶迅速结合形成磷酰化胆碱酯酶,使胆碱酯酶失去水解乙酰胆碱的能力。,Once organophosphate pesticides enter into body,it will bind rapidly to cholinesterase and form phosphorylated cholinesterase,thus make cholinesterase lose the abilit
21、y to hydrolyze acetylcholine.,病因与发病机制,导致组织中的乙酰胆碱过量蓄积,产生胆碱能神经功能紊乱,先表现为兴奋,然后出现抑制。,bring out excessive accumulation of acetycholine in tissue,Which result in disfunction of Cholinergic Nerve.It manifestates excitement at first and then inhibition.,护理评估 Nursing assessment 袁清红,临床表现胆碱能危象急性有机磷农药中毒的典型表现,Cli
22、nical SituationCholinergiccrisis Typical performance of AOPP.,护理评估 Nursing assessment,毒蕈碱样症状主要是副交感神经兴奋所致,临床表现有恶心,呕吐,腹痛,多汗,流涎,瞳孔缩小,支气管痉挛,分泌物增多,心率减慢,气急,严重者出现肺水肿,MuscarinicsymptomsMainlycausedbytheparasympatheticnervousexcitement,Clinicalmanifestationshavenausea,vomiting,abdominalpain,sweating,salivati
23、on,miosis,bronchospasmandIncreasedsecretions heart rate decreased,dyspnea,the serious cases appear pulmonary edema.,护理评估 Nursing assessment,烟碱样症状患者常有肌束颤动,肌肉强直性痉挛,心率加快,甚至全身抽搐,最后出现肌麻痹,呼吸肌麻痹引起周围性呼吸衰竭,Nicotine-likesymptomsPatientsoftenhavemusclebundleof trembling,tetanic spasm,heartrateincreased,Even th
24、e whole body twitching,finally,myoplegia happen,breath myoparalysiscause peripheralrespiratoryfailure,护理评估 Nursing assessment,中枢神经系统症状表现为头晕,头痛,疲乏无力,共济失调,烦躁不安,意识模糊,抽搐及昏迷,CentralnervoussystemsymptomsManifestedasdizziness,headache,fatigue,ataxia,irritability,confusion,convulsionsandcoma,护理评估 Nursing as
25、sessment 莫思慧,急性有机磷中毒分为轻、中、重三级:轻度中毒:头晕、头痛、恶心、呕吐、多汗、流涎、视力模糊、瞳孔缩小、全血胆碱脂酶活力一般在7050。,AOPP can be divided into 3 grades:mild,moderate,severeMild poisoning:dizziness,headache,nausea,vomiting,sweating,salivation,blurred vision,miosis,and the whole blood cholinesterase activity was in the 50 70%,护理评估 Nursing
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