经皮电刺激足三里穴在有机磷农药中毒患者抢救中的作用及安全性研究
发布时间：2018-08-06 11:28
【摘要】：目的:通过选择我院急诊科首诊的口服有机磷农药中毒患者,按照有机磷农药中毒诊疗规范,给予反复洗胃、导泻清除胃肠道内残留毒物,阿托品对抗毒蕈碱样症状,氯解磷定恢复胆碱酯酶活力,保护胃粘膜及促进血液内毒物代谢,必要时呼吸机辅助呼吸等综合治疗的基础上,同时配合应用经皮电刺激足三里穴位治疗,观察临床导泻效果及减少呕吐不良反应的作用,观察对心、肝等重要脏器的保护和降低不良并发症发生率的作用,观察治疗效果及治愈率,并监测操作过程对机体血流动力学的影响及有无晕针、皮肤损伤等不良事件,以评价经皮穴位电刺激足三里对有机磷农药中毒患者抢救治疗作用及其安全性。方法:选择2013年9月~2014年12月邢台市人民医院急诊科首诊的口服有机磷农药中毒患者62例,按照单纯随机抽样分组原则分为试验组和对照组各31例,两组患者均按照有机磷农药中毒诊疗规范给予综合治疗,包括反复洗胃、导泻清除胃肠道内残留毒物,阿托品对抗毒蕈碱样症状,氯解磷定恢复胆碱酯酶活力,保护胃粘膜及促进血液内毒物代谢,必要时建立人工气道、呼吸机辅助呼吸和血液透析治疗等。试验组在洗胃后胃管内注入甘露醇导泻和药用炭片吸附毒物前,配合应用经皮电刺激双侧足三里穴位,1次/8h,30min/次,对照组常规应用导泻剂和吸附剂。观察两组患者首次彻底洗胃后胃管内注入导泻剂所致的呕吐发生率,应用导泻剂后首次大便时间和排出黑便时间,导泻期间每日排便次数,达到阿托品化时间及阿托品使用总量,胆碱酯酶活力恢复时间,发生呼吸衰竭给予气管插管、呼吸机治疗率,观察血清CK、CK-MB、LDH值3d后变化评估心肝等重要脏器损伤细胞恢复情况,两组患者住院时间、治愈率和死亡例数,试验组行经皮穴位电刺激治疗前、1min、5min及治疗后心率(H)、收缩压(SBP)、舒张压(DBP)、平均动脉压(MBP)及末梢血氧饱和度(Sp O2)变化,并观察治疗过程中有无不良事件如:局部皮肤损伤、肌肉酸痛、晕针等反应发生,以评价此治疗技术的安全性。结果:两组患者首次彻底洗胃再胃管内注入导泻剂后的呕吐情况比较,对照组呕吐发生率明显高于试验组,两组比较差异有统计学意义{32.2%(10例)比9.7%(3例),P0.05},两组患者首次大便时间、首次排出黑便时间比较,试验组首次排便时间、首次排出黑便时间明显缩短,两组比较差异有统计学意义(h:9.3±3.6比11.6±5.2,11.3±5.3比14.5±6.8,均P0.05);导泻期间排便次数试验组多于对照组(次/d:4.3±0.53比3.1±0.41,P0.01);两组患者达到阿托品化时间、阿托品使用总量和血清胆碱酯酶恢复到正常1/2时间比较,比较差异有统计学意义(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);两组患者呼吸机治疗率(13%比35%)和平均住院时间(d:11.3±2.8比13.4±4.2)比较,试验组优于对照组,差异有统计学意义(P0.05);两组患者治疗3d后测定血清CK、CK-MB、LDH值变化比较,试验组明显优于对照组(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);试验组行经皮穴位电刺激治疗前、1min、5min及治疗后心率(H)、收缩压(SBP)、舒张压(DBP)、平均动脉压(MBP)及末梢血氧饱和度(Sp O2)变化不明显,治疗后与治疗前比较差异无统计学意义{心率(次/min):119.1±8.1、116.2±8.7、120.1±9.1比118.2±10.9,收缩压(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,舒张压(mm Hg):80.9±15.8、78.5±17.9、77.2±18.2比76.1±17.2,平均动脉压(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}。经皮穴位电刺激治疗过程中未见局部皮肤损伤、晕针、肌肉酸痛等不良反应发生,说明此项操作是安全的。结论:1口服有机磷农药中毒的患者在给予洗胃、导泻剂及综合治疗的基础上,采用中西医结合治疗理论,配合经皮电刺激足三里穴,可降低导泻剂应用后呕吐发生率,增强导泻效果,促使胃肠道内毒物尽快排出。2有机磷农药中毒的患者配合经皮电刺激足三里穴治疗,可减少住院期间阿托品使用总量,缩短达到阿托品化时间,缩短患者住院时间,促进血清胆碱酯酶活力的恢复,保护心、肝等重要脏器细胞,提高临床治疗效果。3经皮穴位电刺激治疗对机体影响小,无不良反应及晕针等意外情况发生,是安全有效的治疗措施,为临床抢救口服有机磷农药中毒患者胃肠道毒物尽早、安全的清空和提高临床疗效提供了一种方便、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.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R595.4
本文编号：2167596
[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.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R595.4
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