2021年急性中毒总论讲稿.pdf

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1、资料收集于网络如有侵权请联系网站删除谢谢精品文档急性中毒总论讲稿一、概述1.中毒：有毒物质进入人体后，达到中毒量而产生全身性损害。引起中毒的物质称为毒物。急性中毒是指短时间内吸收大量毒物，起病急骤，症状严重，病情变化迅速，如不及时治疗常危及生命。（无特异性诊断指标）病因：职业性中毒、生活性中毒：误食、意外、故意投毒、自杀2.毒物的吸收、代谢及排出：吸收：呼吸道、消化道、皮肤黏膜进入人体。职业中毒-口鼻（粉尘、烟雾、蒸汽、气体）。生活中毒主要经口，除CO 代谢：吸收后经血分布全身，主要在肝脏代谢。大多数代谢后毒性降低（解毒），也有毒性增强（对硫磷氧化为对氧磷，毒性增 300倍）排出：主要由肾脏排

2、出，气体和易挥发毒物可以原形经呼吸道排出3.中毒机制局部腐蚀、刺激作用：强酸、强碱吸收组织水分，并与蛋白或脂肪结合，使细胞变性、坏死缺氧：CO、硫化氢、氰化物等窒息性毒物可阻碍氧的吸收、转运、利用，使机体组织、器官缺氧。麻醉作用：脑组织和细胞膜脂类含量高，有机溶剂和吸入性麻醉剂有强的亲脂性，能通过血脑屏障，抑制脑功能抑制酶的活力：毒物或其代谢产物可抑制酶的活力而对人体产生毒性。如：有机磷杀虫药抑制胆碱酯酶，氰化物抑制细胞色素氧化酶，精品w o r d 学习资料 可编辑资料-精心整理-欢迎下载-第 1 页，共 6 页资料收集于网络如有侵权请联系网站删除谢谢精品文档重金属抑制含巯基的酶。干扰细胞或

3、细胞器的生理功能：四氯化碳三氯甲烷自由基，作用肝细胞膜中的不饱和脂肪酸，产生脂质过氧化，使线粒体、内质网变性，肝细胞坏死。受体竞争；阿托品竞争阻断毒蕈碱受体，产生毒性作用。二、临床特点：毒物接触史中毒临床表现复杂，症状缺乏特异性问病史尤为重要。平素精神状态、长期服用的药物、家中药品有无缺少。CO中毒需问炉火、通风情况、有无煤气泄漏，同室居住人员是否有同样表现。食物中毒，应询问同餐进食者有无类似症状发生。相当一部分病人家属手里拿着药瓶、农药瓶。临床表现：表现为各个系统出现相应临床表现，如皮肤黏膜、眼神经系统、呼吸系统、消化系统、循环系统、血液系统。三、实验室检查：尿液检查血液检查：外观：褐色：高

4、铁血红蛋白生成性毒物粉红色：溶血性毒物生化检查：肝功、肾功、凝血四项、动脉血气、异常血红蛋白检测、酶学检查毒物检测：理论诊断最客观，特异性强，但敏感性低，临床可精品w o r d 学习资料 可编辑资料-精心整理-欢迎下载-第 2 页，共 6 页文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3

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11、:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3资料收集于网络如有侵权请联系网站删除谢谢精品文档操作性差，故不能过分依赖毒物检测。四、诊断与鉴别诊断接触史+临床表+相应实验室检查，并排除其他有相似症状的疾病。对不明原因出现的抽搐、昏迷、休克、呼吸困难，通过既往病史不能解释的情况都应想到中毒的可能。急诊处理五、治疗原则1.立即脱离中毒现场，终止与毒物继续接触。2.迅速清除体内已被吸收或未吸收的毒物3.如有可能，尽早使用特效解毒药4.对症支持治疗治疗措施1.评估生命体征：如出现呼吸、循环功能不稳定，象休克、严重低氧血症和呼吸心脏骤停，应立即进行心肺复苏。2.脱离中毒现场

12、，终止毒物接触：毒物经呼吸道或皮肤侵入，脱离现场，移至空气新鲜地方，脱去污染衣物，用清水或肥皂水清洗接触部位的皮肤毛发。3.清除体内尚未吸收的毒物：对口服者尤为重要，毒物清除越早、越彻底，病情改善越明显，预后越好a.催吐（物理、药物）b.洗胃：一般在服毒 6 小时内洗胃效果最好，临床即使超 6 小时也洗，部分毒物仍留胃中。腐蚀性毒物一般不洗，可引起消化道穿孔。昏迷病人洗胃保护呼吸道，避免复苏误吸。具体方法护理操作。反复、大量、清水精品w o r d 学习资料 可编辑资料-精心整理-欢迎下载-第 3 页，共 6 页文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M

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20、注碳酸氢钠。酸化尿液：大量维生素C。5.高压氧治疗：有毒气体中毒，CO、氯气、HS.CO 特效治疗：促进碳氧血红蛋白解离，加速CO排出，减少迟发脑病发生。6.血液净化治疗：把患者的血引出体外，通过净化装置除去其中有毒物质，达到净化血液清除毒物的一系列技术。a.血液透析：可清除分子量500D、水溶性强、蛋白结合率低：醇类、水杨酸、苯巴比妥、茶碱。氯酸盐、重铬酸盐中毒易引起急性肾功能衰竭，首选此法。b.血液灌流：对分子量50040000D水溶、脂溶均有清除作用，包括镇静催眠药、解热镇痛药、洋地黄、有机磷杀虫药、毒鼠强，其对脂溶性强、蛋白结合率高、分子量大清除能力远大血液透析，故常做急性中毒首选净化

21、方式。c.血浆置换：主要清除蛋白结合率高、分布容积小的大分子物质，对蛇毒、毒蕈生物毒及砷化氢等溶血性毒物疗效佳，可补充血中有益成分，如活性的胆碱酯酶。7.特殊解毒药物的应用a.金属中毒解毒药：氨羧螯合剂，可与多种金属形成稳定可溶的金属螯合物排出体外，主要治疗铅中毒：依地酸钙钠。巯基螯合剂：常用精品w o r d 学习资料 可编辑资料-精心整理-欢迎下载-第 4 页，共 6 页文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V

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23、5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O

24、1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编

25、码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q

26、3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T

27、6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D

28、10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3资料收集于网络如有侵权请联系网站删除谢谢精品文档药物二巯基丙醇、二巯基丙磺钠、二巯丁二钠：此类药物均含活性巯基，进入人体可与金属形成无毒、难解离的可溶性螯合物随尿排出体外还能夺取已与酶结合的重金属，使酶恢复活力，主要治疗砷、汞、铜、锑、铅中毒b.高铁血红蛋白血症解毒药：用美蓝（亚甲蓝）。小剂量（12）亚甲蓝可使高铁血红蛋白还原正常血红蛋白，亚硝酸盐、苯胺、硝基苯等高铁血红蛋白生成性毒物中

29、毒的特效解毒药。大剂量（10）亚甲蓝效果刚相反，可产生高铁血红蛋白血症，适用于氰化物中毒的治疗c.氰化物中毒解毒药：一般采用亚硝酸盐硫代硫酸钠疗法。中毒后立即给亚硝酸盐，适量亚硝酸盐可使血红蛋白氧化，产生一定量的高铁血红蛋白。高铁血红蛋白一方面能与血中氰化物结合，另一方面还能夺取已与氧化型细胞色素氧化酶结合的氰离子，形成氰化高铁血红蛋白。后者与硫代硫酸钠作用，可转化为毒性较低的硫氰酸盐排出体外，从而达到解毒目的d.中枢神经抑制剂中毒解毒药：纳洛酮：阿片受体拮抗剂，对麻醉镇痛所致呼吸抑制有特异性拮抗作用。对急性酒精中毒和镇静催眠药中毒引起意识障碍亦有较好疗效。氟马西尼：苯二氮卓类中毒的特效解毒药

30、8.对症治疗：大多数中毒并无特殊解毒疗法，只能通过积极的对症支持治疗，帮助危重患者度过难关，为重要器官功能恢复创造条件。具体措施：保持呼吸道通畅，充分供氧。输液或鼻饲供给营养，选用精品w o r d 学习资料 可编辑资料-精心整理-欢迎下载-第 5 页，共 6 页文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3

31、文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:C

32、B8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8

33、U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 H

34、A1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X

35、10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3

36、 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3

37、J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3资料收集于网络如有侵权请联系网站删除谢谢精品文档适当抗生素防治感染，选用适当抗生素防治感染，应用巴比妥类、地西泮等抗惊厥治疗，对脑水肿、肺水肿、呼吸衰竭、休克心律失常、肾功能衰竭、电解质、酸碱平衡紊乱积极治疗。精品w o r d 学习资料 可编辑资料-精心整理-欢迎下载-第 6 页，共 6 页文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D

38、10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V

39、2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA

40、5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O

41、1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编

42、码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q

43、3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3文档编码:CB8Q3T8U5T6 HA1D10X10V2M3 ZA5Q3J2O1M3