急性重症有机磷农药中毒患者死亡危险因素分析-急诊医学专业论文.docx

PAGE PAGE 10 均为急性重度有机磷农药中毒，其中男性 9 例，女性 15 例，所有患者均行机械 通气,所有患者均存在肺部感染，其中 6 例患者为心肺复苏术后，并发症以肝损 伤、心肌损伤、上消化道出血、急性胰腺炎及多器官功能衰竭为主。从死亡组与 存活组的临床资料比较来看，死亡组与存活组组在平均年龄、服毒的剂量、服毒 至就诊开始洗胃时间及入院时的胆碱酯酶水平之间存在差异，且两组比较 P 值小 于 0.05,差异具有统计学意义，表明这些因素影响患者的最终预后。两组患者在 各种并发症的发生率上，存活组较死亡组组相比较，明显少于死亡组，通过统计 学分析，存在统计学差异，具有统计学意义。两组研究结果显示死亡组与治愈组 病人的早期肝功能指标 ALT,AST 都有升高，两组之间有统计学差异。死亡组升高 较明显，这也可能与死亡组中毒后心跳呼吸骤停发生较多，缺氧情况较重有关。 而两组病人的肾功能指标 BUN,CR 有统计学差异，考虑与有机磷农药及中毒后造 成的缺血缺氧有关，但其能否作为影响有机磷中毒预后的因素有待探讨。 结论：患者主要死亡原因是呼吸、循环衰竭，再此基础上合并多脏器衰竭， 此外与存活组相比，死亡组患者胆碱酯酶水平偏低、血液中毒物浓度较高、年龄 偏大、服毒量较大、服毒至洗胃时间较长，心肌损伤、肝功能损伤等脏器损伤是 增加死亡患者死亡风险的主要因素。 关键词：AOPP；阿托品；胆碱酯酶复能剂；心肺复苏；呼吸衰竭；死亡； 多器官功能障碍综合征 英文摘要： Acute severe organophosphorus pesticide poisoning death in patients with risk factors analysis Abstract Objective Acute Organophosphorus pesticide poisoning（AOPP） is a common pesticide poisoning, usually respiratory failure is the leading cause of death in patients. In recent years, the understanding of the pathological mechanisms of organophosphate poisoning deepening, improved treatment modalities. Ventilator use, simple respiratory failure due to reduction in the event of death in patients with the causes and circumstances of death in patients with the corresponding changes also occurred, collected some severe organophosphate poisoning patients medical records related analysis, sum up experience and lessons learned to explore a more reasonable and effective acute organophosphorus poisoning treatment programs to provide new ideas and methods for the clinical treatment. Methods From February 2000 to February 2010 my hospital for treatment of severe acute organophosphate poisoning patients clinical data, selected candidates within 24 hours of hospital treatment in patients with acute severe poisoning and assault the amount of pralidoxime chloride therapy(the amount of the first day is about 10g, used in conjunction with the following methods：pralidoxime chloride 1g intramuscularly, 1 hour, connected to three times, once every two