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

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(P0.05)。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(120.2±96.31 vs 39.5±62.0,P=0.042)。入院第1天,死亡组Pa O2/Fi O2、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Ach E明显低于治愈组,差异均有统计学意义(P0.05)。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。

Clinical Analysis of the Death Factors of Multiple Organ Dysfunction Syndrome Caused by Acute Organophosphorus Pesticide Poisoning

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.