口服有机磷农药中毒临床观察及护理.docx

摘要：目的 探讨口服有机磷农药中毒患者的临床观察和护理。方法 将我院收治的72例口服有机磷农药中毒患者平均分为观察组和对照组。对两组患者实施临床护理。对照组患者采用常规急救护理方法护理。观察组患者在对照组患者基础上实施干预护理。结果 观察组患者的临床治疗总有效率为94.4%，明显高于对照组患者的69.4%，组间比较差异显著（P0.05），具有可比性。1.2方法 入院后立即对两组患者实施抢救治疗，给予对照组患者常规急救护理，给予观察组患者常规急救护理加干预护理。具体护理方法如下。1.2.1对照组 对照组患者入院后，医护人员立即向患者家属询问，了解患者服用有机磷农药的种类、剂量、时间，及时进行抢救。洗胃过程中，密切关注患者各项生命体征的变化，如患者洗胃过程中出现呼吸困难、心跳停止，应立即停止洗胃，予以心肺复苏抢救；抢救成功后，密切关注患者意识、瞳孔和各项生命体征的变化，详细记录抢救成功后患者临床症状的变化，为医生提供有效的临床治疗信息；大多数有机磷农药中毒患者的气道分泌物都会增多，发生充血、水肿等症状，继而导致患者出现呼吸衰竭。因此在临床治疗过程中，应加强对患者呼吸系统的护理，密切关注患者的呼吸频率、脉搏、血氧饱和度，必要时采用呼吸机进行辅助呼吸，对于存在意识障碍的患者，1d内多次为患者翻身、拍背和吸痰，同时可根据医嘱适当给予患者利于痰液排出的药物。1.2.2观察组 观察组患者的具体干预护理内容为心理护理和饮食护理。口服有机磷农药中毒患者，大多数都存在心理问题，护理人员应根据患者的心理状况，进行具有针对性的心理护理，用真诚的态度与患者进行沟通，倾听患者的苦恼，鼓励患者积极面对生活，打消轻生念头，促进患者疾病早日康复；由于患者口服农药中毒后，对自身肠道黏膜产生的刺激较大，再加上临床治疗反复洗胃，导致患者胃液和肠液大量流失，造成营养不良，因此应适当给予患者补充氨基酸和脂肪等高能量营养物质。1.3评价标准 显效：临床症状完全消失，胃肠功能完全恢复。有效：临床症状明显改善，胃肠功能基本恢复。无效：治疗前后临床症状无明显变化或病情加重死亡。1.4统计学分析 本次研究所得数据采用SPSS18.0统计学软件进行统计分析，计数资料采用百分比（%）表示，采用2进行检验，P0.05代表差异具有统计学意义。2 结果观察组患者的临床治疗总有效率为94.4%，明显高于对照组患者的69.4%。组间比较差异显著（P0.05），见表1。3 讨论有机磷农药引发中毒主要是药物成分中的有机磷对人体内胆碱酯酶具有抑制作用，使其失去水解乙酰胆碱的能力。临床上治疗有机磷农药中毒的主要方法为洗胃，彻底清洗患者的胃部，清除毒性残留是患者抢救成功的关键3。大多数有机磷农药中毒患者均为自主服用药物，具有轻生倾向，因此在临床抢救和治疗的基础上，还应对患者的实施有效的干预护理，消除患者的轻生念头，促使患者积极面对生活，这也是有机磷农药中毒患者临床抢救成功的关键4。我院本次针对有机磷农药中毒患者的临床护理进行了研究，研究结果显示观察组患者的临床治疗总有效率明显高于对照组患者，组间比较差异显著（P0.05），由此可见对口服有机磷农药中毒患者实施干预护理，对于提高临床抢救成功率和降低有机磷农药中毒患者死亡率具有重要意义。Abstract: objective to investigate the oral clinical observation and nursing in patients with organophosphorus pesticide poisoning. Methods will our hospital 72 cases of oral organophosphorus pesticide poisoning were divided into observation group and control group. Implementation of clinical nursing on two groups of patients. The control group were treated by routine emergency nursing methods. Based on the observation group of patients in the control group patients to intervene. Results the observation group of patients with clinical treatment the total effective rate was 94.4%, significantly higher than the control group 69.4% of the patients, the more significant difference between groups (P 0.05), comparable.1.2 method Immediately after admission to the implementation of the rescue treatment in both groups, control group patients routine emergency care, observation group patients routine emergency care and nursing intervention. Specific nursing method is as follows.1.2.1 the control group (1) the control group patients after admission, medical personnel immediately asked the patients families, understand the patients take the kinds of organophosphorus pesticide, dosage, time and in a timely manner to save. In the process of gastric lavage, pay close attention to the variety of the vital signs, such as difficulty breathing, appeared in the process of gastric lavage in patients with cardiac arrest, should immediately stop the gastric lavage, give cardiopulmonary resuscitation (CPR); (2) after the success of the rescue, pay close attention to patients consciousness, pupil and the changes of vital signs, detailed record the changes of clinical symptoms in patients after successful rescue and provide effective clinical treatment for doctors information; (3) most of the organic phosphorus pesticide poisoning patients with airway secretions increase, the symptom such as congestion, edema, which in turn lead to respiratory failure patients. Therefore in the process of clinical treatment, we should strengthen the nursing of patients with respiratory system, pay close attention to the patients breathing rate, pulse, blood oxygen saturation, when necessary assist breathing with ventilator, and for patients with there is disturbance of consciousness, several times within 1 d for patients with sputum suction roll over, back and, at the same time, according to the doctors advice to give appropriate for patients with sputum from the drugs.1.2.2 group observation group of patients with specific nursing intervention contents for psychological nursing and diet nursing. (1) oral organophosphorus pesticide poisoning patients, most of them are psychological problems and nursing personnel should according to patients psychological status, targeted psychological care, with sincere attitude to communicate with patients, listening to the patients distress, actively encourage patients to face life, dispel suicide, promote disease patients recover soon; (2) due to pesticide poisoning patients, in their intestinal mucosa stimulation, combined with the clinical treatment of recurrent gastric lavage, leading to loss of gastric juice and intestinal juice, causes malnutrition and therefore should be added to the patients with appropriate high-energy nutrients such as amino acid and fat.* 1.3 evaluation criteria: clinical symptoms disappear completely, gastrointestinal function fully recovered. Effective: clinical symptoms improved significantly, basic gastrointestinal function recovery. Invalid: before and after treatment of clinical symptoms or aggravation of death has no obvious change.1.4 statistical analysis The data from this study using SPSS18.0 statistical software for statistical analysis of count data using percentage (%), said by chi-square test, P 0.05, on behalf of the difference is statistically significant.2 the resultsObservation group of patients with clinical treatment the total effective rate was 94.4%, significantly higher than the control group 69.4% of the patients. The more significant difference between groups (P 0.05), see table 1.3 discussOrganophosphorus pesticide poisoning main is the ingredient of organophosphorus bladder alkali esterase has inhibitory effect to human body, make it lose the ability of the hydrolysis of The main method for the clinical treatment of organophosphorus pesticide poisoning gastric lavage, thoroughly clean the patients stomach, remove toxic residue is the key to success 3 to save the patient.Most organophosphorus pesticide poisoning patients take their medicine are independent, have suicidal tendency, therefore on the basis of clinical rescue and treatment, also deal with patients with effective nursing intervention, eliminate the patients suicide, pro