急性有机磷农药中毒致肾损害临床分析

目的探讨急性有机磷农药中毒致肾损害患者的发病机制、临床表现和治疗方法，提高抢救成功率。方法收集我院1999年1月。2010年12月收治的急性有机磷农药中毒致肾损害患者的临床资料。回顾患者临床表现特点、综合性治疗措施以及预后。结果共收集急性有机磷农药中毒患者456例，其致肾损害105例，发病率23％，临床表现以蛋白尿（100％）、镜下血尿（93％）为突出表现，部分患者可出现急性肾功能不全（39％），中毒程度较重的患者可出现1个或多个重要脏器并发症。105例患者治愈97例，治愈率达92．4％，死亡8例，病死率7．6％，死亡的主要原因为多脏器功能衰竭。结论急性有机磷农药中毒致肾损害的预后不仅仅是由肾功能损害程度决定的，它合并其他重要脏器衰竭或严重感染，是导致患者死亡的重要因素，所以，治疗上除尽早、足量使用抗胆碱能药和胆碱脂酶复能剂外，积极采取综合性措施预防和治疗并发症，是提高急性有机磷农药中毒致肾损害患者抢救成功率的重要环节。

Clinical Analysis of Renal Damage Due to Acute Organophosphorus Pesticide Posioning

Objective To investigate the mechanism,chnical manifestation and therapeutic methods of the renal damage flue to acute organophosphorus pesticide poisoning to increase the successful rate of emergency treatment. Methods The clinical data of the renal damage due to acute organophosphorus pesticide poisoning was collected from January 1999 to December 2010 in our hospital. The characteristics of the patients,clinical manifestation and the comprehensive therapeutic measures as well as the prognosis were retrospectively analyzed. Results A total of 456 cases of organophosphorus pesticide poisoning were collected;105 cases were renal dam- age,the morbidity rate was of 23%. The prominent clinical manifestation were proteinuria（ 100% ）,microscopic hematuria（93% ）;Some patients can produce renal insufficiency （39%）;One or more than one important organs damage may occur in patients with more severe poisoning. 97 of the 105 patients with pesticide poisoning were cured, and the cure rate was 92.4%;8 cases died, and the fatality rate was 7.6%. The main cause of the death was multi-organ functional failure. Conclusion The prognosis of renal damage due to acute organic phosphorus pesticide poisoning is not determined only by the renal damage extent,it combined other important-organ-failure or severe infections,which were the important factors of inducing the patient death. Therefore,on the therapeutic methods,we should actively use the comprehensive measures to prevent and treat the complications besides the full dose of anticholinergic as soon as possible,which is the important key link of enhancing the successful rate of emergency treatment for patients with renal damage due to acute organic phosphorus pesticide poisoning.