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一氧化碳中毒的护理(一氧化碳中毒的处置)
塔米酉 发表于:2021-6-27 13:28:21 复制链接 发表新帖
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一氧化碳中毒的护理(一氧化碳中毒的处置)
关于一氧化碳中毒
一氧化碳是含碳物质不完全燃烧所产生的一种无色、无味、无臭、无刺激性气体,不溶于水,比空气轻,当空气中的一氧化碳含量达到0.04%,就可使人中毒。与氧气相比,一氧化碳与血红蛋白的亲和力更高,可高达300倍,因此,当一氧化碳被人体吸入后,会使血红蛋白丧失携带氧气的能力,从而造成细胞死亡,甚至危及生命。

中毒原因1.在密闭居室中使用煤炉取暖、做饭或吃炭火锅,由于通风不良,供氧不充分,导致室内大量一氧化碳积聚。2.城市居民使用管道燃气,如阿里朵宝宝果管道漏气,开关不紧,均可使一氧化碳大量溢出。
3.使用燃气热水器,通风不良,洗浴时间过长。
4.汽车停驶时,开着空调在车窗紧闭的车内睡觉,发动机排出的一氧化碳会聚集在车内。

中毒机制
一氧化碳吸入体内后,与血液中血红蛋白结合,形成稳定的碳氧血红蛋白(COHb)。CO与Hb的亲和力比氧与Hb的亲和力大300倍,比氧和血红蛋白(O2Hb)的解离慢3600倍。所以,吸入较低浓度的CO即可产生大量COHb,因而可使组织缺氧。组织缺氧加重,中枢神经首先受累,严重者出现脑水肿、继发性脑血管病变、缺氧性脑病及形成后遗症或迟发性脑病、心肌损害和各类心律失常。

临床表现
临床表现:与血液内含碳氧血红蛋白(COHb)的浓度有关。
轻度中度:血液COHb浓度达10%-20%。表现为头晕、头痛、恶心、呕吐、全身无力。

中度中毒:血液COHb浓度达30%-40%。患者口唇呈“樱桃红色”,上述症状加重,出现兴奋、判断力减低、运动失调、幻觉、视力减退、意识模糊或浅昏迷。

重度中毒:血液COHb浓度达30%-50%。表现为抽搐、深昏迷、低血压、心律失常和呼吸衰竭,部分患者因误吸发生吸入性肺炎,也可发生应激性溃疡、大脑局部性损害,受压部位皮肤可出现类似烫伤的红肿、水疱,受压部肌肉可发生压迫性肌肉坏死,释放肌球蛋白而导致急性肾功能衰竭。
症状识别
1. 评估环境:首先查看是否有密闭环境内煤炉取暖或煤气热水器烧水等状况,如有应以低姿进入室内立即打开门窗。

2. 病情观察:观察并询问患者有无异常感觉及特殊表现,轻度煤气中毒患者可自觉头晕、头痛、头胀、耳鸣、恶心、心悸、嗜睡、乏力、运动时呼吸困难等,在呼吸新鲜空气后以上症状可迅速缓解;中毒煤气中毒患者可表现呼吸及脉搏增快、烦躁不安、步态不稳、颜面潮红,口唇呈樱桃红色,瞳孔对光反射迟钝,甚至轻度昏迷;重度煤气中毒患者呈现昏迷、反射消失、大小便失禁、体温升高、血压下降、瞳孔散大、呼吸不规则等。

如何救护怀疑存在煤气中毒,应立即将患者移至通风环境中,并拨打急救电话。
对于意识清醒的患者,且症状不重的轻度煤气重度患者,在及时呼吸新鲜空气缓解症状后,可就近送医院就诊。
若患者呼吸、心跳停止,若无旁人协助,施救者在做心肺复苏的同时,可利用手机的免提功能,拨打急救电话,就诊医院需选择具备高压氧舱治疗条件的医院。

急救措施1.脱离中毒环境,除让患者立即呼吸新鲜空气外,还应立即将其安置成侧卧位,并松开患者衣领,确保呼吸道通畅,防止窒息。注意保暖,并密切观察患者意识、呼吸及脉搏等情况。
2.氧疗:是治疗一氧化碳中毒最有效的方法,给氧能加速血液COHb解离和CO排出。轻度中毒:给予鼻导管吸入高浓度氧气;中重度中毒:高压氧治疗。
3. 机械通气:对昏迷、窒息或呼吸停止应及时行气管插管,进行机械通气。
4.防止脑水肿:对有昏迷或抽搐者,阿里朵宝宝早期可在头部置冰袋,以减轻脑水肿;静脉快速滴注甘露醇或用速尿等脱水剂,降低颅内压,减轻脑水肿。
5.降温疗法:对昏迷持续时间超过10小时以上,有高热和频繁抽搐者,积极采取降温疗法。进行物理降温,头部用冰帽、体表用冰袋,使肛温保持在32℃左右。如降温效果不好,可用冬眠疗法。
6.抢救苏醒后应绝对卧床休息,观察2周,做好患者的口腔护理、皮肤护理。
7.促进脑细胞功能的恢复:三磷酸腺苷、辅酶A、细胞色素C和大量维生素C等。
8。防止并发症和后遗症:昏迷患者保持呼吸道通畅,必要时行气管插管,注意营养。

注意措施1. 当患者意识不清时,禁止给其喂食任何东西,如食醋、酸菜汤等,以防窒息。
2. 若患者呈仰卧位,为避免因呕吐等原因引起窒息,应将患者头偏向一侧,并清理口腔内分泌物及呕吐物。
3. 将患者移至室外后应注意保暖,避免患者因受冻导致肺炎等。
4. 对于意识清醒的煤气中毒患者,应及时前往医院进行检查。
5. 部分机型煤气中毒患者在昏迷苏醒后,意识恢复正常,但可有一个月左右的假愈期,假愈期后可出现神经精神症状,如反应迟钝、癫痫发作、帕金森综合征等,需要患者家属密切注意。

预防措施1.应定期检查煤气管道及阀门,避免因设备老化造成煤气泄露。

2.在每次做饭后应及时关闭阀门。

3.家中可安装煤气报警器进行检测及报警。

4.对于家中需烧煤、烧炭的人群,在使用煤炉、火坑等取暖设备时,应注意开窗通风。

5.汽车尾气中含有大量一氧化碳,应避免在长时间停车时,使用空阿里朵宝宝调。

6.如果是工业性中毒,指导患者工作中,学会保护自己。

在安全问题上,容不得半点麻痹和侥幸,必须防范在先,警惕在前。

只有这样,才能为我们的生命筑起安全的屏障。



                                       
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Robertfug 发表于 2021-7-28 01:16:45 | 阅读全部

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