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【PPT版】临床医师如何急诊洗胃

  • 2026-11-10 03:53:02
【PPT版】临床医师如何急诊洗胃

洗胃术是将胃管插入患者胃内，通过灌注与抽吸液体，清除胃内未被吸收的毒物、药物或残留食物的急救与治疗技术，广泛应用于急性中毒、上消化道出血术前准备等场景。

临床常用洗胃溶液的选择
毒物种类
常用洗胃溶液
禁忌溶液
备注说明
有机磷农药（如敌敌畏）
2%碳酸氢钠溶液/1:5000高锰酸钾溶液
敌百虫禁用碳酸氢钠（会转化为毒性更强的敌敌畏）；对硫磷禁用高锰酸钾（会氧化为毒性更强的对氧磷）
需根据具体农药种类精准选择，洗胃后可辅以阿托品、胆碱酯酶复能剂治疗
镇静催眠药（如巴比妥类）
1:5000高锰酸钾溶液/清水
硫酸镁（可加重中枢抑制）
深昏迷患者需警惕误吸，可配合利尿剂促进毒物排泄
阿片类药物（吗啡、哌替啶）
1:5000高锰酸钾溶液/清水
无特殊禁忌
洗胃后可使用纳洛酮等特异性拮抗剂
酒精中毒
清水/1%碳酸氢钠溶液
无特殊禁忌
昏迷患者避免洗胃，优先采取催吐、补液、促进代谢等措施
腐蚀性毒物（强酸/强碱）
牛奶/蛋清/氢氧化铝凝胶（强酸）；食醋（强碱）
洗胃（可造成消化道穿孔）
严禁洗胃，需尽快给予黏膜保护剂，强酸禁用碳酸氢钠（会产生大量气体导致穿孔）
重金属（铅、汞、砷）
蛋清/牛奶/浓茶/二巯丙醇溶液
无特殊禁忌
牛奶、蛋清可吸附重金属，浓茶中的鞣酸能与重金属形成不溶性复合物
灭鼠药（磷化锌）
1:5000高锰酸钾溶液/0.5%硫酸铜溶液
牛奶/蛋清/脂肪类食物（可促进磷的溶解吸收）
硫酸铜可使磷化锌转化为无毒的磷化铜，洗胃后可用硫酸钠导泻
氰化物（如氰化钠）
3%过氧化氢溶液/1:5000高锰酸钾溶液
无特殊禁忌
洗胃后需立即给予亚硝酸钠、硫代硫酸钠等解毒剂联合治疗
特殊人群洗胃错误操作
特殊人群
常见错误
错误后果
纠正方案
儿童
用成人胃管 / 进液量按成人标准
黏膜损伤、胃穿孔、水电解质紊乱
① 胃管：8~12Fr，测量长度为鼻尖→耳垂→剑突下（儿童 10~15cm）；② 进液量：5~10ml/kg/ 次，总量根据年龄调整（避免＞1000ml）
妊娠晚期
平卧位洗胃 / 进液量过多
子宫受压导致胎儿缺氧、胃穿孔
① 体位：右侧卧位（减轻子宫对胃的压迫）；② 进液量：300ml / 次，减少胃内压力
严重心肺功能不全
未监护即长时间洗胃
诱发心衰、呼吸衰竭
① 全程心电监护，吸氧；② 缩短洗胃时间（控制在 30 分钟内），必要时分多次进行；③ 备好急救药物（西地兰、呋塞米）
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  2. SHOW FULL COLUMNS FROM `fenlei` [ RunTime:0.000820s ]
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  6. SELECT * FROM `set` [ RunTime:0.000351s ]
  7. SHOW FULL COLUMNS FROM `article` [ RunTime:0.000645s ]
  8. SELECT * FROM `article` WHERE `id` = 493547 LIMIT 1 [ RunTime:0.000334s ]
  9. UPDATE `article` SET `lasttime` = 1794299100 WHERE `id` = 493547 [ RunTime:0.001090s ]
  10. SELECT * FROM `fenlei` WHERE `id` = 64 LIMIT 1 [ RunTime:0.000308s ]
  11. SELECT * FROM `article` WHERE `id` < 493547 ORDER BY `id` DESC LIMIT 1 [ RunTime:0.000398s ]
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  13. SELECT * FROM `article` WHERE `id` < 493547 ORDER BY `id` DESC LIMIT 10 [ RunTime:0.000550s ]
  14. SELECT * FROM `article` WHERE `id` < 493547 ORDER BY `id` DESC LIMIT 10,10 [ RunTime:0.000617s ]
  15. SELECT * FROM `article` WHERE `id` < 493547 ORDER BY `id` DESC LIMIT 20,10 [ RunTime:0.000642s ]
0.103029s