全肠道灌洗治疗急性中毒

РsalicylateР32%Р60РliquidРacetaminophenР20%Р被忽视的肠道毒物Р《普罗帕酮自杀中毒38例》? 导泻仅4例(10.5%)Р《氯氮平中毒的临床特征和诊疗现状》? 成人组60例,导泻10例(16.7%)Р 中国急救医学,2011,31(3):244-246? 中华急诊医学杂志,2007,16(7):773-774Р影响毒物吸收的因素РPoisonРPatientРPathophysiologyРdose/concentrationРTotal absorptive surface area?AgeРAnticholinergic effects due to the poisonРPhysical form:? solid (immediate release, controlled release, seed), ? liquidРSaturability of transport proteins РEnterohepatic recirculationРHypotension or hypothermia causing hypoperfusion to the gut ?HypoxaemiaРPhysicochemical properties? (pKa、solubility)РGastrointestinal motility?Gastrointestinal milieu: food, enzymes,?bacterial flora, pHРGastric irritation (increased gut motility)РClin 2007; 46 (11): 897-939Р清除肠道毒物的必要性Р大部分经肠道吸收中毒Р洗胃对毒物的清除有限Р毒物的延迟吸收(缓释/控释、肠溶、转运蛋白、肠蠕动减弱、肠道低灌注/缺氧)