Opioid poisoning caused 10 cases of respiratory and circulatory failure

Opiate drug abuse is often caused by poisoning. 1 clinical data Since January 1998 to April 2003, the Division I reception opiate drug poisoning caused by respiratory and circulatory failure in patients with 10 cases, 9 man, 1 woman, aged 19 to 35 years old; 7 cases at the same time drinking liquor (alcohol Concentration of 38 ~ 52 °) 150 ~ 300ml range. All patients in the incidence of the former intravenous opioids over. Onset 10min ~ 4h, was found by family members or friends, or sent directly from the ambulance to take my rescue Branch. 10 hospitalized patients in varying degrees in a coma, respiratory depression or respiratory arrest, shock or blood pressure measuring blood pressure less than that associated with incontinence. 3 cases when patients have respiratory cardiac arrest, the two-mydriasis fixed. According to the history of drug abuse along the blood vessels of the eye of a needle injection, coma, respiratory depression, decreased blood pressure, the size of the tip of the pupil can make a diagnosis. 2 treatment 2.1 rescue immediately placed on a bed or on a stretcher to remove secretions in the nose and mouth, respiratory tract smooth, high concentrations of oxygen, the rapid establishment of intravenous access. 2.2 intravenous naloxone for the first time 0.8 ~ 1.2mg, and then 1.6 ~ 2.4mg in 5% glucose infusion in 250ml, or 10 ~ 15min to repeat intravenous 0.8mg, dose adjustments based on condition, the speed of delivery and delivery time . With the total amount of each drug wake-up time. 2.3 At the same time, the use of respiratory stimulants Lobeline, Lamine, Su-Ling back, first of all an intravenous (for 3mg, 0.375g, 8mg), and then the 3 by adding sugar to maintain the intravenous infusion of saline in 250ml. 2.4 The expansion of the main anti-shock with low molecular weight dextran and sugar, salt, according to the first principles of the fast after the slow infusion. 2.5 boost dopamine drugs, Alamin According to the regulation of blood pressure and the speed of the situation and, if necessary, the use of adrenaline. 2.6 control 20% of cerebral edema 125ml mannitol and furosemide 20mg used interchangeably, each 6 ~ 8h1 times. 2.7 can be used early hormone dexamethasone, for the first time 20mg, if necessary, 6 ~ 8h repeat 1st, total no more than 60mg. 2.8 maintain the airway and, if necessary, to endotracheal intubation, and artificial ventilators. 2.9, if necessary, ECG and blood gas custody. 2.10 anti-infective and attention to the correct water-electrolyte and acid-base disorders. 3, the results of After the above-mentioned treatment, with the exception of 3 patients on admission heartbeat, breathing has stopped those who died, the other 7 patients were cured and discharged, the average length of stay is 24 ± 9h. 4 discussion Opioids have a strong analgesic, cough, central nervous system suppression after the first excitement, mainly to control. Opiate of the most serious side effect of inhibiting the brain stem is the respiratory center and central pontine respiratory conditioning, central respiratory failure is the leading cause of death. This group of 7 patients are cured typical clinical manifestations of opioid poisoning and the other 3 cases when the patient to breathe cardiac arrest, mydriasis, fixed, which is not typical clinical features, both died, may be related to the amount injected too much Poisoning or too long, as a result of respiratory depression, the brain caused by cerebral edema and hypoxia, leading to respiratory and circulatory failure. Naloxone is a rescue opiate drug poisoning key drug detoxification, which is specific opioid receptor antagonist, and the opioid receptor affinity than morphine, and can stop and replace the morphine-like substance with the receptor-binding, it can lift the hub Inhibition; naloxone at the same time also the effects of acute alcohol poisoning antidote. Excessive alcohol can have a constricting effect on the central nervous system, opioids can reduce the respiratory center of the sensitivity of blood carbon dioxide tension, at the same time to adjust to the bridge in the brain respiratory center also inhibit the drug may increase the drink on the role of the respiratory depression, Increase the poisoning, respiratory and circulatory failure to speed up. To the use of naloxone as soon as possible, re-use, dosage should be individualized, in patients with clear-up. Airway is always the key, reasonable and comprehensive treatment is necessary, the use of naloxone at the same time the application of respiratory stimulants, anti-shock, prevention and treatment of cerebral edema, to correct water-electrolyte and acid-base disorders, as well as support for the symptomatic treatment. Respiratory failure due to severe lack of oxygen, leading to diffuse brain edema, cell membrane stability in the application of hormones can reduce the brain edema and contribute to the improvement of the condition, should be used early. The depth of opiate poisoning patients in critical condition, ferocious, but as long as a timely rescue, emergency treatment and appropriate measures, to save a lot of success, the key is early detection, early treatment, early rescue.