目的：觀察慢性酒精中毒所致震顫譫妄的臨床特點(diǎn)及預(yù)后。方法：對(duì)32例慢性酒精中毒所致震顫譫妄患者的臨床資料進(jìn)行回顧性分析，探討其臨床特點(diǎn)及預(yù)后。結(jié)果：32例患者中，因應(yīng)激方式不當(dāng)飲酒者19例，平均飲酒年齡20.3±9.6年，平均每日攝入乙醇量276.4±21.9 g。因戒斷而出現(xiàn)臨床癥狀者15例。臨床表現(xiàn)為多種精神癥狀和不同程度的意識(shí)障礙，伴有肢體震顫。頭部CT掃描發(fā)現(xiàn)腦萎縮者30例。經(jīng)治療后癥狀痊愈者25人，好轉(zhuǎn)者4人。結(jié)論：慢性酒精中毒所致震顫譫妄發(fā)作的病理生理機(jī)制尚不明了，但其發(fā)作與戒斷關(guān)系密切，經(jīng)積極干預(yù)可獲得較滿意的預(yù)后。
目的 研究慢性飲酒對(duì)大鼠注射油酸-脂多糖致急性肺損傷（ALI）的影響，以及損傷后肺組織氧化/抗氧化平衡的改變。方法 32只SD大鼠隨機(jī)予以慢性飲酒或飲水；6周后隨機(jī)注射油酸-脂多糖致ALI（損傷組），或注射生理鹽水作為對(duì)照（對(duì)照組）。共分為4組：飲酒損傷組、飲水損傷組、飲酒對(duì)照組和飲水對(duì)照組，每組8只動(dòng)物。檢測(cè)其PaO2，肺組織中還原型谷胱苷肽（GSH）和丙二醛（MDA）水平，以及肺組織干質(zhì)量/濕質(zhì)量比值（W/D）的變化。結(jié)果 與相應(yīng)對(duì)照組比較，飲酒損傷組和飲水損傷組PaO2明顯下降，W/D值明顯增加，GSH水平降低，MDA水平升高（P均lt;0.05）。飲酒損傷組與飲水損傷組比較，除W/D值變化無(wú)顯著差異外，其余指標(biāo)下降均更顯著（P均lt;0.05）。結(jié)論 慢性飲酒可增加創(chuàng)傷后感染時(shí)肺損傷的嚴(yán)重程度，與肺組織氧化/抗氧化失衡有關(guān)。
目的 探討慢性甲醇中毒性眼部損害的臨床特點(diǎn)。 方法 對(duì)26例慢性甲醇中毒患者進(jìn)行了眼底、視野、眼電生理及眼底熒光血管造影檢查，分析其結(jié)果。 結(jié)果 該組患者視力明顯受損，早期眼底視盤色澤正常，晚期表現(xiàn)為視神經(jīng)萎縮，周邊視野先受損害，逐漸向中心侵犯，視誘發(fā)電位P100波潛伏期延長(zhǎng)，振幅值下降。 結(jié)論 甲醇中毒性眼損害主要部位在視神經(jīng)，預(yù)后較差。 (中華眼底病雜志,1998,239-240)
目的 評(píng)價(jià)醒腦靜注射液治療急性酒精中毒的療效。方法 計(jì)算機(jī)檢索 MEDLINE(1989 ~ 2008 年)、中國(guó)期刊全文數(shù)據(jù)庫(kù)(1991 ~ 2008 年)、維普資訊 - 中文期刊數(shù)據(jù)庫(kù)(1991 ~ 2008 年)、萬(wàn)方數(shù)字化期刊群 (1991 ~ 2008 年)、中國(guó)生物醫(yī)學(xué)文獻(xiàn)光盤數(shù)據(jù)庫(kù)(1991 ~ 2008 年)及 The Cochrane Library( 2008 年第 4 期),收 集醒腦靜注射液治療急性酒精中毒的隨機(jī)對(duì)照試驗(yàn),對(duì)納入研究進(jìn)行質(zhì)量評(píng)價(jià)后,采用 RevMan 4.2.2 軟件進(jìn)行 Meta 分析。結(jié)果 共納入 27 篇中文文獻(xiàn),均為低質(zhì)量文獻(xiàn)。Meta 分析結(jié)果顯示,在治療急性酒精中毒時(shí),西醫(yī) 常規(guī) + 醒腦靜治療在顯效時(shí)間和有效時(shí)間上明顯優(yōu)于單純西醫(yī)常規(guī)治療,其 WMD(95%CI)分別為 – 90.62 min (– 121.12,– 60.11)和 – 124.97 min(– 183.54,– 66.40);西醫(yī)常規(guī) + 醒腦靜治療急性酒精中毒在顯效時(shí)間上較西醫(yī)常規(guī)治療 + 納洛酮略慢,但有效時(shí)間與西醫(yī)常規(guī)治療 + 納洛酮治療比較,其差異無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論 現(xiàn)有研究表明, 西醫(yī)常規(guī) + 醒腦靜注射液治療急性酒精中毒療效優(yōu)于單純西醫(yī)常規(guī)治療;在常規(guī)治療相同的情況下,醒腦靜注射 液與納洛酮療效相似。
目的:探討使用院前指數(shù)(Prehospital Index, PHI)及格拉斯哥昏迷評(píng)分(Glasgow Coma Score, GCS)兩種創(chuàng)傷評(píng)分法對(duì)院前急救中急性酒精中毒合并外傷性顱內(nèi)出血患者的評(píng)估價(jià)值。方法: 納入68例院前急救中酒精中毒合并頭外傷患者,院前均進(jìn)行PHI及GCS兩種創(chuàng)傷評(píng)分,隨訪至出院,以頭部CT掃描及隨訪結(jié)果作為標(biāo)準(zhǔn)以判斷患者是否伴有顱內(nèi)出血。計(jì)算兩種創(chuàng)傷評(píng)分的敏感度、特異度、陽(yáng)性似然比、陰性似然比、陽(yáng)性預(yù)測(cè)值、陰性預(yù)測(cè)值及Youden指數(shù),并作出受試者工作特征曲線(ROC曲線),以正態(tài)離差值Z檢驗(yàn)兩種評(píng)分法ROC曲線下面積的差異。 結(jié)果: 院前指數(shù)以6分作為診斷界值,敏感度為94.7%,特異度為71.4%;格拉斯哥昏迷評(píng)分以9分作為診斷界值,敏感度為98.8%,特異度為30.6%,PHI及GCS的ROC曲線下面積分別是0.881和0.678,其差異有統(tǒng)計(jì)學(xué)意義。結(jié)論: 在對(duì)急性酒精中毒合并頭外傷患者是否伴有顱內(nèi)出血的院前評(píng)估中,院前指數(shù)較格拉斯哥昏迷評(píng)分更有價(jià)值。
摘要:目的:探討納絡(luò)酮對(duì)急性酒精中毒的臨床療效及經(jīng)驗(yàn)。方法: 將58例酒精中毒患者隨機(jī)分為2組:常規(guī)治療組29例,給予利尿劑、胃腸黏膜保護(hù)劑及靜脈補(bǔ)液對(duì)癥治療;納絡(luò)酮治療組29例,除了應(yīng)用常規(guī)治療方法外,加用納絡(luò)酮。結(jié)果:納絡(luò)酮治療組患者癥狀改善,清醒時(shí)間明顯提前于對(duì)照組(Plt;0.01)。結(jié)論: 納絡(luò)酮治療急性酒精中毒療效肯定、使用簡(jiǎn)單安全,值得臨床推廣使用。Abstract: Objective: To evaluate the clinical effect of naoxone on acute alcoholism. Methods: Fiftyeight cases of acute alcoholism were randomly divided into two groups: remedial group (29 cases) and the comparison group (29 cases). Both groups were given diuretic, protection of mucous membrane of stomach and fluid infusion. The remedial group was treated with naloxone. Results: Symptoms of the remedial group were obviously improved. Consciousness was regained much earlier than that of the comparison group (Plt;0.01). Conclusion: Naloxone can be used effectively and safely in treating acute alcoholism.
摘要:目的:探討加蘭他敏對(duì)急性酒精中毒大鼠海馬神經(jīng)元N甲基D天冬氨酸(NMDA)·R2B的影響。 方法:將60只大鼠分為對(duì)照組、酒精組及加蘭他敏組,每組各20只。酒精組以50％(v/v) 酒精12 mL/kg灌胃兩次/日,共7d。加蘭他敏組酒精(濃度、劑量同上)灌胃的同時(shí)腹腔注射加蘭他敏2mg/kg一次/日,共7d。對(duì)照組以等量生理鹽水灌胃。實(shí)驗(yàn)第8天取大鼠海馬區(qū)做蘇木精伊紅（HE）染色,觀察海馬區(qū)的病理學(xué)變化;免疫組織化學(xué)采用SABC法,觀察海馬區(qū)神經(jīng)元NR2B的表達(dá)。 結(jié)果: 病理學(xué)觀察結(jié)果：對(duì)照組海馬區(qū)神經(jīng)細(xì)胞排列整齊,胞質(zhì)淡染,無(wú)變性、壞死;酒精組神經(jīng)細(xì)胞層次不清、排列松散、細(xì)胞數(shù)量減少,部分細(xì)胞變性;加蘭他敏組神經(jīng)細(xì)胞層次較清、排列較密,細(xì)胞數(shù)目較酒精組增; 免疫組織化學(xué)結(jié)果：酒精組與對(duì)照組比較NR2B陽(yáng)性表達(dá)細(xì)胞數(shù)量明顯減少(Plt;0.01);加蘭他敏組與酒精組比較NR2B陽(yáng)性表達(dá)細(xì)胞數(shù)量明顯增高(Plt;0.05);加蘭他敏組與對(duì)照組比較NR2B表達(dá)細(xì)胞數(shù)量無(wú)明顯差異(Pgt;005)。 結(jié)論: 急性酒精中毒與海馬區(qū)神經(jīng)細(xì)胞的NR2B表達(dá)下調(diào)有關(guān);加蘭他敏具有保護(hù)急性酒精中毒導(dǎo)致的大鼠海馬區(qū)神經(jīng)細(xì)胞毒性的作用,其機(jī)制可能與加蘭他敏上調(diào)NR2B的表達(dá)有關(guān)。Abstract: Objective: To study the effects of galanthamine on NmethylDaspartic acid receptor 2B (NMDAR2B, NR2B) in the hippocampus (HIP) of acute alcoholism rats. Methods: Total of 60 wistar male rats were randomly divided into control group, ethanol group and glanthamine group, and there were 20 rats in each group. The rats in ethanol group were given by intragastric administration with 50% alcohol (v/v) on the dose of 12 ml/kg twice per day, in control group were given by same dose of saline, and in galanthamine group were treated by intragastric administration with the same concentration and dosage of alcohol as in ethanol group and peritoneal injection with 2 mg/kg of galanthamine once per day for 7 days. In eighth day of experiment, the rats were sacrificed under etherization, and pathological changes of HIP’s zone of rat were observed by HEstaining, and expression of NR2B in neurons of HIP’s zone by immunohistochemical SABC method. Results: The results observed by histopathology showed that in control group, neurons of HIP’s zone lined up in order, cytoplasm had faint staining, and were no degeneration and necrosis; in ethanol group, nerve cells’ layer was unclear, structure was loose, cell number reduced and part of cells degenerated; in galanthamine group, layer of neurons was comparatively clear and arrangement was comparatively dense, and the cell number increased obviously more than ethanol group. The results detected by Immunohistochemistry for NR2B showed that the cell number with expression of NR2B in the HIP’s zone decreased significantly in the ethanol group than in the control group (Plt;0.01), increased in the galanthamine group than in the ethanol group (Plt;0.05), and had no difference between the galanthamin and control group (Pgt;0.05). Conclusion: Acute alcoholism may relate to down regulation of expression of neuron’s NR2B in HIP’s zone;The galanthamin has role of protection for neuron in HIP’s zone induced by toxicity of acute alcoholism, and its mechanism may relate to galanthamin upregulation NR2B expression.
目的探討急性酒精中毒存在的安全隱患。 方法將2009年12月－2012年12月急診收治留院觀察的508例急性酒精中毒患者進(jìn)行安全隱患的原因分析并采取相應(yīng)的安全對(duì)策。 結(jié)果508例急性酒精中毒患者經(jīng)全面查體評(píng)估病情、保持呼吸道通暢、建立靜脈通道、加速體內(nèi)乙醇排除、促醒、采取安全防護(hù)措施、加強(qiáng)醫(yī)患溝通，未發(fā)生意外傷害和死亡。 結(jié)論對(duì)急性酒精中毒患者存在的安全隱患應(yīng)高度重視，只有采取相應(yīng)的安全對(duì)策，才能確保患者的安全。
急性酒精中毒是急診最常見的中毒性疾病之一，臨床表現(xiàn)以神經(jīng)系統(tǒng)癥狀為主，并發(fā)癥多樣，合并癥隱匿，醫(yī)療風(fēng)險(xiǎn)高，不良事件時(shí)有發(fā)生，占用急診醫(yī)療資源較多。該文對(duì)急性酒精中毒臨床風(fēng)險(xiǎn)評(píng)估的必要性、依據(jù)及現(xiàn)有方法進(jìn)行了總結(jié)，旨在為臨床早期識(shí)別高?；颊吆蛢?yōu)化急診醫(yī)療資源提供參考。