Objective To construct a nomogram model for predicting delayed encephalopathy after acute carbon monoxide poisoning (DEACMP) in emergency departments. Methods All patients with acute carbon monoxide poisoning who visited the Department of Emergency of Zigong Fourth People’s Hospital between June 1st, 2011 and May 31st, 2023 were retrospectively enrolled and randomly divided into a training set and a testing set in a 6∶4 ratio. LASSO regression was used to screen variables in the training set to establish a nomogram model for predicting DEACMP. The discrimination, calibration, and clinical practicality were compared between the nomogram and Glasgow Coma Scale (GCS) in the training and testing sets. Results A total of 475 patients with acute carbon monoxide poisoning were included, of whom 41 patients had DEACMP. Age, GCS and aspartate aminotransferase were selected as risk factors through LASSO regression, and a nomogram model was constructed based on these factors. The areas under the receiver operating characteristic curves for nomogram and GCS to predict DEACMP in the training set were 0.897 [95% confidence interval (CI) (0.829, 0.966)] and 0.877 [95%CI (0.797, 0.957)], respectively; and those for nomogram and GCS to predict DEACMP in the testing set were 0.925 [95%CI (0.865, 0.985)] and 0.858 [95%CI (0.752, 0.965)], respectively. Compared with GCS, the performance of nomogram in the training set (net reclassification index=0.495, P=0.014; integrated discrimination improvement=0.070, P=0.011) and testing set (net reclassification index=0.721, P=0.004; integrated discrimination improvement=0.138, P=0.009) were both positively improved. The calibration of nomogram in the training set and testing set was higher than that of GCS. The decision curves in the training set and testing set showed that the nomogram had better clinical net benefits than GCS. Conclusion The age, GCS and aspartate aminotransferase are risk factors for DEACMP, and the nomogram model established based on these factors has better discrimination, calibration, and clinical practicality compared to GCS.
目的:探討使用院前指數(Prehospital Index, PHI)及格拉斯哥昏迷評分(Glasgow Coma Score, GCS)兩種創傷評分法對院前急救中急性酒精中毒合并外傷性顱內出血患者的評估價值。方法: 納入68例院前急救中酒精中毒合并頭外傷患者,院前均進行PHI及GCS兩種創傷評分,隨訪至出院,以頭部CT掃描及隨訪結果作為標準以判斷患者是否伴有顱內出血。計算兩種創傷評分的敏感度、特異度、陽性似然比、陰性似然比、陽性預測值、陰性預測值及Youden指數,并作出受試者工作特征曲線(ROC曲線),以正態離差值Z檢驗兩種評分法ROC曲線下面積的差異。 結果: 院前指數以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,其差異有統計學意義。結論: 在對急性酒精中毒合并頭外傷患者是否伴有顱內出血的院前評估中,院前指數較格拉斯哥昏迷評分更有價值。
目的 探討改良洗胃法在急性中毒患者洗胃中的應用效果。 方法 將2010年1月－2012年2月收治的口服藥物中毒需采用電動洗胃機洗胃的患者分為觀察組和對照組，觀察組采用改良洗胃法，對照組采用傳統的洗胃方法，比較兩組患者洗胃總時間、洗胃總液量、一次性插管成功率、堵管發生率及并發癥發生率。 結果 觀察組患者洗胃總時間低于對照組[（28.60 ± 6.32）、（34.51 ± 5.37）min]，洗胃總液量低于對照組[（10 856 ± 3 818）、（17 962 ± 3 855）mL]，差異有統計學意義（P＜0.001）；一次性插管成功率高于對照組（93.02% 、67.44%），差異有統計學意義（P=0.03）；堵管發生率為低于對照組（4.88%、27.91%），差異有統計學意義（P=0.03）；并發癥發生率低于對照組（2.33%、37.21%），差異有統計學意義（P＜0.001）。 結論 改良洗胃法可減少洗胃總時間及洗胃液總量，提高一次性插管的成功率，同時可降低堵管及并發癥的發生率。
目的 探討H2受體拮抗劑和質子泵抑制劑（PPI）緩解急性胃黏膜損傷的時效性研究。 方法 對2008年1月－2010年1月在急診科就診的98例急性乙醇中毒后胃黏膜損傷患者，隨機分為對照組50例，治療組48例。常規給予休息、保暖，補液，維持水、電解質、酸堿平衡，維持循環功能等治療基礎上，對照組給予H2受體拮抗劑治療，治療組給予PPI治療。通過觀察急性胃黏膜損傷患者上消化道癥狀及體征，記錄不同飲酒及飲酒量，并根據患者就診時間及不同飲酒組治療后上消化道癥狀完全緩解時間進行比較。 結果 治療組上消化道癥狀緩解所需時間與對照組比較差異有統計學意義（P＜0.001），不同飲酒組上消化道癥狀緩解時間上差異有統計學意義（P=0.000）。 結論 PPI在緩解急性乙醇中毒所致胃黏膜損傷的時效上更明顯，具有臨床價值。
In order to explore retinal toxicity and to estimatequot;safe dosagequot;of intravitreal gentamicin 21 Dutch-belted rabbits divided into 5 dosage groups and 1 control group were investigated.The results showed that, in 3 000mu;g group, optic disc swelling and vein dilating were observed ophthalmoscopieally. Histopathologie study displayed the retinal necrolysis. In 50~500mu;g groups,the retinal pigment change was revealed within 3~14 days after the injection.Histopathologic study displayed that the retinal damages were confined in outer layers of retina in early stage. Inner layers of retina were also influenced in late stage. The results demontrated that with increasing intravitreal gentamiein,retinal damages are gradully aggravated,and even if intravitreal gentamicin was in minimum dose,retinal damages was still observed. （Chin J Ocul Fundus Dis,1994,10:167-169）
目的:總結急性重癥中毒并急性腎功能衰竭(ARF)的臨床特點并探討多種血液凈化(BP)模式搶救急性重癥中毒的臨床療效。方法:回顧性分析我院30例急性中毒并ARF患者,其中9例行血液透析(HD)治療,11例行HD串聯血液灌流(HD＋HP)治療,10例采用連續性靜脈-靜脈血液透析濾過(CVVHDF)治療,各組均給予綜合性治療,比較單純HD組、HD＋HP組、CVVHDF組之間治療效果。結果:CVVHDF組治愈率高,腎功能恢復優于其他血液凈化組(P﹤0.05),昏迷者的清醒時間快,住院時間縮短(P﹤0.05),無明顯毒副作用。結論:CVVHDF、HD＋HP血液凈化治療搶救各種急性中毒并ARF患者成功率高,對急性重癥中毒伴多器官功能障礙者,提倡早期行CVVHDF治療,同時重視洗胃、營養支持、水電解質酸堿平衡、抗感染等綜合治療,以利于急危重癥中毒患者的救治。
In order to explore the histochemical changes in retina after intravitreal injection of gentamycin,a histochemical quantitative analysis of cytochrome oxidase(CYO)and acetylcholinesterase(ACHE)was performed with a computerized image analysis system and was compared with that of morphological study.The results showed that CYO decreased significantly in 100mu;g dosage group.With increasing intravitreal gentamycin dosage or observed days,CYO decreased gradually in all rabbits.In 100~500mu;g dosage groups,ACHE changed mildly at 3 days of injection.It decreased significantly at 7 days.However,it was destroyed completely in 1000~3000mu;g dosage groups at 3 days. （Chin J Ocul Fundus Dis,1994,10:232-235）