| 梁艳斌 胡家昌 王利民 沈 锋 郑 洁.重度有机磷农药中毒致多器官功能障碍综合症死亡因素的探讨[J].,2015,15(7):1317-1320 |
| 重度有机磷农药中毒致多器官功能障碍综合症死亡因素的探讨 |
| Clinical Analysis of the Death Factors of Multiple Organ DysfunctionSyndrome Caused by Acute Organophosphorus Pesticide Poisoning |
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| DOI： |
| 中文关键词: 有机磷中毒 多 器官功能衰竭综合症 阿托品 氯磷定 |
| 英文关键词: Acute organophosphorus pesticide poisoning (AOPP) Multiple organ dysfunction syndrome (MODS) Atropine Pralidoxime chloride |
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| 中文摘要: |
| 目的： 探讨重度有机磷农药中毒发生多 脏器功能障碍综合症的死亡因 素。 方法： 分析 78 例 急性有机磷农药中毒发生多 脏器
功能障碍综合症的临床资料， 分为 治愈组和死亡组，分别 对两组的一般资料、治疗 过程、并发症等情况进行比较。 结果： 治愈组
64.5%的中毒物为中低毒性， 而死亡组 50%的患者中毒物为高毒类， 两组中毒物毒性程度的构成比比较差异有统计学意义(P<0.
05)。 死亡组患者中毒后至洗胃 的时间间隔较治愈组明显延长(6.8± 4.1 vs 4.2± 3.5h， p=0.038)， 入院 24 小时内 氯磷定用 量明 显低
于治愈组 (6.2± 3.8 vs 8.6± 2.6， P=0.045)。 两组阿托品总用 量及 24 小时总用 量比较未见显著性差异 (669.4± 393.1 vs 427.9±
290.7
， P=0.956)，但死亡组阿托品日 均用 量明 显高于治愈组(1 20.2± 96.31 vs 39.5± 62.0， P=0.042)。 入院第 1 天，死亡组 PaO2/FiO2、
MAP 明显低于治愈组， Scr、 HR 及 CK-MB 明 显高于治愈组； 治疗 3 天后， 死亡组 MAP 仍明显低于治愈组， Scr、 HR 较高，且 AchE
明显低于治愈组， 差异均有统计学意义(P<0.05)。 结论： 中毒物的毒性程度、未能早期足量的应用 肟类复能剂 、过量使用 阿托品或
阿托品中毒、发病初期缺少足够的多 器官功能支持治疗可能是 AOPP 合并 MODS 的患者死亡的重要因 素。 |
| 英文摘要: |
| Objective:To investigate the death factors of multiple organ dysfunction Syndrome (MODS) caused by acute
organophosphorus pesticide poisoning (AOPP).Methods:78 patients of AOPP combined with MODS were selected and devided into
cured group(CG) and died group(DG) according to the outcome. The clinical data including the general information, treatment, complication, etc were analyzed and compared between two groups.Results:In cured group, 64.5% of patients were caused by low toxicity of posison, while 50% patients of the died group were caused by highly toxic poison, and the toxic levels of posison were significantly different between two groups(P<0.05). The time interval from poisoning to gastic lavage of died group was significantly longer than that of the
cured group (6.8± 4.1 vs 4.2± 3.5h, P=0.038). The dosage of pralidoxime chloride in died group in 24 hours after admission was much
lower than the cured group (6.2± 3.8 vs 8.6± 2.6, P=0.045). No significant difference was found in the total dosage of atropine total
dosage of atropine in 24 hours after admission between two groups (669.4± 393.1 vs 427.9± 290.7, P=0.956). However, the daily dosage
of atropine of died group was significantly higher than that of cured group (120.2± 96.31 vs 39.5± 62.0, P=0.042). On the 1 st day after
admission, the PaO2/FiO2, MAP of died group were obviously lower than those of cured group, while the Scr, HR, CK-MB were significantly higher (P<0.05). After 3 days' treatment, the MAP and AchE of died group were still lower, Scr, HR were still higher than those of
cured group(P<0.05).Conclusion:The toxic levels of posison, delayed application of sufficient quantities oximes agent, unproper dosage
of atropine and the lack of adequate early treatment of multiple organ support were the important reasons of high mortality of AOPP patients combined with MODS. |
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