机械通气及大黄在抢救毒蛇咬伤致呼吸衰竭的应用(1)
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【摘要】 目的 探讨毒蛇咬伤致急性呼吸衰竭治疗措施。方法 选择毒蛇咬伤致呼吸衰竭患者46例,治疗方法:①机械通气治疗:患者出现呼吸困难或者呼吸浅慢时,及时气管插管行机械通气。上机模式为辅助/控制通气或同步间歇指令通气,注意观察患者胸廓起伏情况及肺部体征,动态监测脉搏血氧饱和度、X线胸片及血气分析,并视病情变化调整通气参数,使其逐渐达到脱机标准;②生大黄20 g+清水250 ml水煎15 min,管饲,qd,连用3~5 d;③常规治疗:伤口切开排毒及药物局部封闭,及早足量应用抗蛇毒血清等。结果 患者住院时间6~20天,平均(13.4±5.2)d。通气时间<48 h者 28例(60.9%),48~72 h 者12例(26.1%),>72 h者 6例(13.0%)。治愈44例(95.7%),死亡2例(4.3%)。死亡者均是就诊时合并多器官功能障碍者。 结论 机械通气联合大黄、抗蛇毒血清等集束治疗是抢救毒蛇咬伤致呼吸衰竭有效的方法。
【关键词】
毒蛇咬伤;呼吸衰竭;机械通气;大黄
The machine ventilates and Rheubarb is rescuing snake to bite with the result that the application for having respiratory failure
SU Yuenan,ZHANG Yiwei,HUO Daohui,et al.EmergencyDepartment,Yangjiang’s people hospital,Guangdong Yangjiang 529500,China
【Abstract】 Objective To explone the treatment of snake bite with acute respiratory failure.Methods Choice snake bites with the result that have respiratory failure in 46 case,treatment method:①The machine ventilates treatment:The sufferer appears a dyspnea to breathe perhaps shallow slow,the windpipe puts a tube to go a machine to ventilate in time.Start up mode for theassist/control ventilation(A/C)or the synchronously intermittent mandatory ventilation(SIMV),noticing sufferer's chest Kuo of observation to rise and fall circumstance and lung department body to advertise for,the dynamic state monitors pulse blood oxygen saturation degree,X line chest slice and bloodgas analysis,and see condition variety adjustment to ventilate parameter,make it attain offline standard gradually.②Living a Rheubarb 20 g+the clear water 250 ml water fry a 15 mins,tube Si,qd,connect to use 3~5 d.③The normal regulations cures:The wound cuts open row poison and medicine part to close,early the foot measure applied antisnake poisonous serum etc.Results Sufferer stays in the hospital time for6~20 d,average(13.4士5.2)d.Ventilate time for those<48 h was 28 case(60.9%),48~72 hwas 12 cas(26.1%),>72 hwas6 case(13.0%).Cure 44(95.7%),die 2(4.3%).Death all is seek medical advice merge many organ function obstacle.Conclusion Machine ventilates consociation Rheubarb,the antisnake poisonous serum etc.gather to tie a treatment is rescue snake to bite with the result that have a failure in respiring a valid method ......
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