【正文】 Routine Examination of Urine on high power lens we can see 2 to 4 red blood cells, The patient’ s Potassium is mmol/L,calcium is mmol/L and Cardiac enzyme and liver function are normal. CHE 病例介紹 ?89 CHE KU/L,。胸片提示：肺部感染及雙側(cè)胸膜炎。 ?812血常規(guī)正常， CHE32 KU/L ? On 89, CHE 。Chest X ray tip：lung infection and bilateral pleurisy. ?On 812 Blood routine is normal， and CHE is 32KU/L 病因與發(fā)病機(jī)制 謝妹娜 病因 ? 生產(chǎn)及使用過程的不當(dāng)：如生產(chǎn)設(shè)備密封不嚴(yán)導(dǎo)致化學(xué)毒物泄漏；噴灑殺蟲藥過程中經(jīng)皮膚和呼吸道吸收 Etiology ? Improper production and use: For example, production equipment sealed poorly result in leakage of chemical toxicant。 in the process of spraying pesticide , absorbed through skin and airway . 病因與發(fā)病機(jī)制 生活性中毒：主要由于自服、誤服或攝入被污染的水源和實(shí)物水果等。 Living poisoning: Mainly due to drinking or eating contaminated water and fruit voluntarily or by mistake etc. 病因與發(fā)病機(jī)制 有機(jī)磷農(nóng)藥中毒機(jī)制主要是抑制體內(nèi)膽堿酯酶的活性。正常情況下，膽堿能神經(jīng)興奮所釋放的遞質(zhì) —— 乙酰膽堿被膽堿酯酶水解為乙酸及膽堿而失去活性。 ? Mechanism of poisoning ? The Primary mechanism of anophosphate pesticide poisoning is inhibition of the action of cholinesterase in body. In general, excitement of cholinergic nerve releases neurotransmitter acetylcholine which can be hydrolyzed to choline and acetic acid by cholinesterase and lose its activity. 病因與發(fā)病機(jī)制 有機(jī)磷農(nóng)藥進(jìn)入人體后與體內(nèi)膽堿酯酶迅速結(jié)合形成磷?；憠A酯酶，使膽堿酯酶失去水解乙酰膽堿的能力 。 ? Once anophosphate pesticides enter into body, it will bind rapidly to cholinesterase and form phosphorylated cholinesterase, thus make cholinesterase lose the ability to hydrolyze acetylcholine. 病因與發(fā)病機(jī)制 導(dǎo)致組織中的乙酰膽堿過量蓄積，產(chǎn)生膽堿能神經(jīng)功能紊亂，先表現(xiàn)為興奮，然后出現(xiàn)抑制。 ? bring out excessive accumulation of acetycholine in tissue,Which result in disfunction of Cholinergic Nerve. It manifestates excitement at first and then inhibition . 護(hù)理評(píng)估 Nursing assessment 袁清紅 ? 臨床表現(xiàn) ? 膽堿能危象 急性有機(jī)磷農(nóng)藥中毒的典型表現(xiàn) ? Clinical Situation ? Cholinergic crisis Typical performance of AOPP . 護(hù)理評(píng)估 Nursing assessment ? 毒蕈堿樣癥狀 ? 主要是副交感神經(jīng)興奮所致 , 臨床表現(xiàn)有惡心 ,嘔吐 ,腹痛 ,多汗 ,流涎 ,瞳孔 縮小 ,支氣管痙攣 ,分泌物增多 ,心率減慢 ,氣急 ,嚴(yán)重者出現(xiàn)肺水腫 ? Muscarinic symptoms ? Mainly causedby the parasympathetic nervous excitement, Clinical manifestations have nausea,vomiting, abdominal pain, sweating,salivation, miosis, bronchospasm and Increased secretions heart rate decreased, dyspnea, the serious cases appear pulmonary edema. 護(hù)理評(píng)估 Nursing assessment ? 煙堿樣癥狀 ? 患者常有肌束顫動(dòng) ,肌肉強(qiáng)直性痙攣 ,心率加快 ,甚至全身抽搐 ,最后出現(xiàn)肌麻痹 ,呼吸肌麻痹引起周圍性呼吸衰竭 ? Nicotinelike symptoms ? Patients often have muscle bundle of trembling, tetanic spasm ,heart rate increased , Even the whole body twitching, finally, myoplegia happen,breath myoparalysis cause peripheral respiratory failure 護(hù)理評(píng)估 Nursing assessment ? 中樞神經(jīng)系統(tǒng)癥狀 ? 表現(xiàn)為頭暈 ,頭痛 ,疲乏無力 ,共濟(jì)失調(diào) ,煩躁不安 ,意識(shí)模糊 ,抽搐及昏迷 ? Central nervous system symptoms ? Manifested as dizziness, headache, fatigue, ataxia, irritability, confusion, convulsions and a 護(hù)理評(píng)估 Nursing assessment 莫思慧 ? 急性有機(jī)磷中毒分為輕、中、重三級(jí)： ? 輕度中毒：頭暈、頭痛、惡心、嘔吐、多汗、流涎、視力模糊、瞳孔縮小、全血膽堿脂酶活力一般在 70％－ 50％。 ? AOPP can be divided into 3 grades: mild, moderate, severe ? Mild poisoning： dizziness, headache, nausea,vomiting, sweating, salivation, blurred vision, miosis, and the whole blood cholinesterase activity was in the 50 ~ 70% 護(hù)理評(píng)估 Nursing assessment ? 中度中毒：除上述癥狀外，還出現(xiàn)肌纖維顫動(dòng)、瞳孔明顯縮小、輕度呼吸困難、大汗、腹痛、腹瀉、意識(shí)清楚或輕度障礙、步態(tài)蹣跚。全血膽堿脂酶活力降至 50％－ 30％ 。 ? Moderate poisoning： In addition to these above, symptoms also include muscular fibrillation, mild dyspnea, sweat, abdominal pain, diarrhea, clear or mild disorders of consciousness, and staggering gait. Whole blood cholinesterase activity declined to 50% 30%. 護(hù)理評(píng)估 Nursing assessment ? 重度中毒：除上述癥狀外，發(fā)生肺水腫、驚厥、昏迷及呼吸麻痹。全血膽堿脂酶活力降至 30％以下。 ? Severe poisoning： In addition to these above, symptoms also include pulmonary edema, convulsions, a and respiratory paralysis. Whole blood cholinesterase activity declined to below 30% . 護(hù)理評(píng)估 Nursing assessment 王麗煒 ? 有機(jī)磷農(nóng)藥中毒后，經(jīng)急救臨床癥狀好轉(zhuǎn)，可在數(shù)日到一周內(nèi)突然再次發(fā)生昏迷，甚至發(fā)生肺水腫或突然死亡，此為中毒后反跳現(xiàn)象。 ? Organophosphorus pesticide poisoning were the first aid clinical symptom, can be in a few days to get better within a week, even happen again suddenly a pulmonary edema or sudden death, says bounce phenomenon . 護(hù)理評(píng)估 Nursing assessment ? 這與殘留在皮膚 、 毛發(fā)和胃腸道的有機(jī)磷農(nóng)藥重吸收或解毒藥 停用過早或減量過快等原因有關(guān) 。 ? This and remain in the skin, hair and the gastrointestinal tract is absorbed by heavy or antidote to credit dose or reasons such as too early on. 護(hù)理評(píng)估 Nursing assessment ? 在急性中毒癥狀緩解后遲發(fā)性神經(jīng)病變發(fā)病前，一般在中毒后24~96小時(shí)突然發(fā)生以呼吸肌麻痹為主的癥狀群，稱“中間型綜合征”。 ? In patients with acute poisoning symptoms after the lateoccurred neuropathy, generally in the poisoning before 24 to 96 hours after happen suddenly by respiratory muscular paralysis primarily the symptoms, says middle type syndrome. 護(hù)理評(píng)估 Nursing assessment ? 發(fā)病機(jī)制可能與膽堿酯酶長期受到抑制，影響神經(jīng)肌肉接頭突觸后功能有關(guān)。 ? The mechanism may and cholinesterase longterm effect is restrained, neuromuscular postsynaptic functioning. 治療原則 嚴(yán)超 ?治療原則 ?我們都知道，中毒后，我們要迅速清除毒物，一般來說越快洗胃效果越好 ? Treatment principle ? As we know, the most important of all is removing toxic as quickly as we can when someone poisoned. Generally speaking, the faster lavage the better effect we get. 治療原