急性有机磷农药中毒患者发生认知功能障碍相关影响因素分析

目的 探讨急性有机磷农药中毒（acute organophosphorus pesticide poisoning，AOPP）患者发生认知功能障碍的相关影响因素。 方法 选取AOPP患者156例，根据是否发生认知功能障碍分为观察组（60例）与对照组（96例）。收集2组中毒到入院时间、中毒程度、急性病理生理和慢性健康评分Ⅱ（acute physiology and chronic health evaluation Ⅱ，APACHE Ⅱ评分）、胆碱酯酶（cholinesterase，CHE）恢复时间等临床资料，分析认知功能障碍发生的影响因素，并构建预测模型。 结果 观察组和对照组年龄、中毒剂量、中毒程度、CHE恢复时间、APACHE Ⅱ评分、住院时间差异有统计学意义（P＜0.05）。Logistic回归分析结果显示，年龄、中毒程度、CHE恢复时间、APACHE Ⅱ评分、住院时间是AOPP患者认知功能障碍发生的独立危险因素（P＜0.05）。构建AOPP患者发生认知功能障碍的Logistic回归风险预测模型：-4.782+年龄×2.507+中毒程度×2.778+CHE恢复时间×2.646+APACHE Ⅱ评分×2.905+住院时间×2.320，模型拟合效果较好（P＜0.05）；模型预测AOPP患者发生认知功能障碍的曲线下面积为0.931，敏感度为83.33%，特异度为86.46%。 结论 AOPP患者易发生认知功能障碍，主要受年龄、中毒程度、CHE恢复时间、APACHE Ⅱ评分、住院时间等因素影响，根据上述因素建立Logistic回归预测模型预测认知功能障碍发生情况具有较高价值，临床应重视CHE恢复时间、APACHE Ⅱ评分等，有利于指导后续治疗，改善预后。

Analysis of influencing factors related to the occurrence of cognitive dysfunction in patients with acute organophosphorus pesticide poisoning

Objective To investigate the influencing factors associated with the occurrence of cognitive dysfunction in patients with acute organophosphorus pesticide poisoning (AOPP).Methods One hundred and fifty-six patients with AOPP were selected and divided into the observation group (n=60) and the control group (n=96) according to occurrence of cognitive dysfunction. Clinical data such as duration from poisoning to hospital admission, degree of poisoning, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, and recovery time of cholinesterase (CHE) were collected from the two groups to analyze the factors influencing the occurrence of cognitive dysfunction and to construct a prediction model.Results There were statistically significant differences in age, poisoning dose, degree of poisoning, CHE recovery time, APACHEⅡ score, and length of hospitalization between observation group and control group (P＜0.05).Logistic regression analysis showed that age, degree of poisoning, recovery time of CHE, APACHEⅡ score, and length of hospitalization were independent risk factors for the development of cognitive dysfunction in AOPP patients (P＜0.05). A logistic regression risk prediction model for the occurrence of cognitive dysfunction in AOPP patients was constructed: -4.782 + age × 2.507 + degree of poisoning × 2.778 + CHE recovery time × 2.646 + APACHEⅡ score × 2.905 + length of hospitalization ×2.320, with a good model fit (P＜0.05).The area under the curve of the model in predicting the occurrence of cognitive dysfunction in AOPP patients was 0.931, with a sensitivity of 83.33% and a specificity of 86.46%.Conclusion AOPP patients are prone to cognitive dysfunction, which is mainly influenced by age, degree of poisoning, CHE recovery time, APACHEⅡ score, and length of hospitalization. It is of high value to establish a logistic regression prediction model to predict the occurrence of cognitive dysfunction based on the above factors, and clinical attention should be paid to CHE recovery time and APACHEⅡ score, which is helpful to guide the follow-up treatment and improve the prognosis.