小兒(er)時期可能發生的中(zhong)(zhong)(zhong)毒(du)(du)(du)和意(yi)外事故(gu)是多方面的，特(te)點是中(zhong)(zhong)(zhong)毒(du)(du)(du)與周圍環(huan)境密(mi)切(qie)相關，常為(wei)急(ji)性(xing)中(zhong)(zhong)(zhong)毒(du)(du)(du)，其方式有五種:（1）攝入(ru)(ru)中(zhong)(zhong)(zhong)毒(du)(du)(du);（2）接觸中(zhong)(zhong)(zhong)毒(du)(du)(du);（3）吸(xi)入(ru)(ru)中(zhong)(zhong)(zhong)毒(du)(du)(du);（4）注入(ru)(ru)中(zhong)(zhong)(zhong)毒(du)(du)(du);（5）直腸吸(xi)收中(zhong)(zhong)(zhong)毒(du)(du)(du)。其中(zhong)(zhong)(zhong)攝入(ru)(ru)中(zhong)(zhong)(zhong)毒(du)(du)(du)最為(wei)多見。本文所討論的中(zhong)(zhong)(zhong)西醫結合(he)抽吸(xi)洗胃法主要應用(yong)于兒(er)科急(ji)性(xing)攝入(ru)(ru)中(zhong)(zhong)(zhong)毒(du)(du)(du)，經我院兒(er)科臨床觀察取得了良好的療效，報告如下。

1臨床資料

患(huan)兒，男(nan)，6歲。就診(zhen)時嗜睡，流(liu)涎，呼(hu)吸急(ji)促，小便失(shi)禁。家(jia)屬訴發現家(jia)中盛裝殺蟲藥(yao)(yao)的(de)汽水瓶已空（藥(yao)(yao)物(wu)名稱(cheng)及成分不(bu)詳(xiang)）。查體:T39.0℃，R40次/min，P145次/min，BP60/40mmHg。意識模糊，雙瞳孔對光(guang)反射存在，雙肺(fei)干濕(shi)羅音(yin)(yin)，心(xin)音(yin)(yin)有力，節律不(bu)整(zheng)，腹部無壓痛及肌(ji)緊張，四肢(zhi)肌(ji)張力增高。診(zhen)斷:急(ji)性不(bu)明藥(yao)(yao)物(wu)中毒(du)(du)，給予(yu)催吐，經(jing)鼻(bi)下胃管，抽(chou)吸殘留毒(du)(du)物(wu)后(hou)注(zhu)(zhu)入中藥(yao)(yao)解毒(du)(du)劑，方(fang)劑如下:地漿水30g，綠豆12g，甘(gan)(gan)草12g，金銀(yin)花6g，滑石12g，煎汁(zhi)（煮沸5min后(hou)即(ji)可不(bu)斷取(qu)適量，加(jia)冷水應用(yong)，每次注(zhu)(zhu)入胃容量的(de)1/3，反復灌注(zhu)(zhu)抽(chou)吸）。方(fang)藥(yao)(yao)分析(xi):地漿:甘(gan)(gan)寒(han)，瀉熱(re)解毒(du)(du)，解一切魚肉、草果、藥(yao)(yao)物(wu)、諸菌毒(du)(du)。綠豆:甘(gan)(gan)寒(han)，清熱(re)解毒(du)(du)，行十(shi)二經(jing)，一切草木金石砒霜毒(du)(du)皆治之(zhi)。甘(gan)(gan)草:味(wei)甘(gan)(gan)，通行十(shi)二經(jing)，解百藥(yao)(yao)毒(du)(du)。金銀(yin)花:甘(gan)(gan)平(ping)，清熱(re)解毒(du)(du)，補虛(xu)。滑石:甘(gan)(gan)寒(han)，利水通淋，清熱(re)除濕(shi)。以(yi)上諸藥(yao)(yao)合用(yong)，共(gong)奏清熱(re)、利水、排毒(du)(du)之(zhi)功(gong)。（3）經(jing)胃管注(zhu)(zhu)入導瀉劑。常規對癥處理，靜脈(mo)輸液，經(jing)積極(ji)搶(qiang)救，患(huan)兒痊愈出院。

2討論

在(zai)(zai)(zai)實際臨床(chuang)工作(zuo)中(zhong)(zhong)(zhong)面對小兒急(ji)(ji)性(xing)攝入中(zhong)(zhong)(zhong)毒(du)(du)(du)(du)(du)常(chang)會(hui)遇到以下難點(dian):（1）無法及時(shi)準(zhun)確應(ying)用(yong)(yong)特效(xiao)解毒(du)(du)(du)(du)(du)劑(ji)(ji)(ji)(ji)。由于年齡小，自(zi)我保護能(neng)力差，凡兒童能(neng)接觸到的(de)物(wu)(wu)品如藥物(wu)(wu)、植物(wu)(wu)以及農藥、殺蟲(chong)劑(ji)(ji)(ji)(ji)、去污(wu)劑(ji)(ji)(ji)(ji)等(deng)(deng)化學制(zhi)(zhi)劑(ji)(ji)(ji)(ji)都可能(neng)造(zao)成兒童誤服。毒(du)(du)(du)(du)(du) 物(wu)(wu)種類(lei)繁多(duo)加之幼兒主(zhu)訴不明確導致診斷困(kun)難。（2）解毒(du)(du)(du)(du)(du)藥物(wu)(wu)劑(ji)(ji)(ji)(ji)量不易控制(zhi)(zhi)，毒(du)(du)(du)(du)(du)副作(zuo)用(yong)(yong)較小。常(chang)造(zao)成患(huan)兒驚厥、胃(wei)(wei)(wei)內出(chu)血(xue)、高(gao)鈉(na)血(xue)癥、嘔吐后(hou)誤吸等(deng)(deng)。本(ben)法針對于以上難點(dian)采用(yong)(yong)中(zhong)(zhong)(zhong)藥煎劑(ji)(ji)(ji)(ji)經(jing)胃(wei)(wei)(wei)管注入，中(zhong)(zhong)(zhong)和(he)、清洗(xi)毒(du)(du)(du)(du)(du)物(wu)(wu)，彌補(bu)了常(chang)規洗(xi)胃(wei)(wei)(wei)法的(de)不足。廣(guang)大醫(yi)(yi)(yi)護人員往往認為“中(zhong)(zhong)(zhong)醫(yi)(yi)(yi)不治急(ji)(ji)癥”，在(zai)(zai)(zai)面對急(ji)(ji)性(xing)中(zhong)(zhong)(zhong)毒(du)(du)(du)(du)(du)類(lei)病例(li)中(zhong)(zhong)(zhong)首(shou)先考慮西(xi)醫(yi)(yi)(yi)特效(xiao)解毒(du)(du)(du)(du)(du)劑(ji)(ji)(ji)(ji)，然而在(zai)(zai)(zai)遇到毒(du)(du)(du)(du)(du)物(wu)(wu)性(xing)質不明或(huo)此(ci)(ci)種毒(du)(du)(du)(du)(du)物(wu)(wu)尚無特效(xiao)解毒(du)(du)(du)(du)(du)劑(ji)(ji)(ji)(ji)時(shi)感(gan)到左右為難，往往延(yan)誤治療。祖(zu)國醫(yi)(yi)(yi)學在(zai)(zai)(zai)此(ci)(ci)時(shi)仍(reng)能(neng)發揮巨大作(zuo)用(yong)(yong)，中(zhong)(zhong)(zhong)藥制(zhi)(zhi)劑(ji)(ji)(ji)(ji)采用(yong)(yong)西(xi)醫(yi)(yi)(yi)胃(wei)(wei)(wei)管抽吸灌(guan)注法具(ju)有(you)及時(shi)性(xing)、廣(guang)譜性(xing)、安全性(xing)，在(zai)(zai)(zai)對急(ji)(ji)性(xing)不明原(yuan)因(yin)中(zhong)(zhong)(zhong)毒(du)(du)(du)(du)(du)或(huo)尚無解毒(du)(du)(du)(du)(du)劑(ji)(ji)(ji)(ji)藥物(wu)(wu)中(zhong)(zhong)(zhong)毒(du)(du)(du)(du)(du)中(zhong)(zhong)(zhong)具(ju)有(you)一定(ding)優勢(shi)。

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