院前系统救治对重度急性有机磷农药中毒预后的影响

目的探讨口服重度急性有机磷农药中毒(SAOPP)患者服毒至救治时间(无治疗期)的长短与患者预后的关系。方法选择经过院前系统救治后接回医院的174例SAOPP患者作为治疗组,自行前往医院或拒绝院前洗胃者160例为对照组。两组治疗方法为洗胃、应用氯磷定、阿托品及对症治疗等综合措施。统计患者无治疗期的长短与死亡、严重并发症的发生情况;观察症状消失时间、全血乙酰胆碱酯酶(AChE)活力恢复至正常时间、阿托品化时间、阿托品用量、氯磷定用量、纳洛酮用量与住院天数等指标。结果治疗组无治疗期时间为(1.2±0.3)h,而对照组为(2.8±0.5)h,差异有统计学意义(P<0.01);治疗组死亡11例(死亡率6.32%),对照组死亡36例(死亡率22.50%),差异有统计学意义(P<0.01);治疗组呼吸衰竭、心脏损害、脑损害、阿托品中毒、中间综合征、肝损害发生率分别为12.64%、5.75%、8.62%、1.72%、4.60%、5.17%,与对照组(25.63%、13.75%、17.50%、6.25%、7.50%、9.38%)的差异有统计学意义(P<0.05或P<0.01);治疗组的中毒症状消失时间、阿托品化时间、AChE恢复至正常时间、阿托品用量、氯磷定用量、纳络酮用量、住院天数各指标均明显优于对照组,差异有统计学意义(P<0.05或P<0.01)。结论院前系统救治可改善SAOPP患者的预后,值得推广应用。

Effect of the pre-hospital systematic treatment on prognosis of patients with severe acute organophosphorus pesticide poisoning

OBJECTIVE: To investigate if the duration from poisoning to treatment (no treatment period) is related to the prognosis of patients with severe acute organophosphorus pesticide poisoning (SAOPP). METHODS: One hundred and seventy-four patients with the pre-hospital systematic treatment served as the treatment group while 160 patients going to the hospital by themselves without treatment or rejecting gastrolavage served as the control group. Patients in both groups were treated by gastrolavage, pralidoxime chloride, atropine and other expectant treatment. The duration of no treatment period, death, and severe complication were observed. The time of disappearance of symptoms, the recovery time of acetyl cholinesterase (AChE), atropinization time, atropine dosage, pralidoxime chloride dosage, naloxone dosage, hospitalization days and other targets were also observed. RESULTS: The duration of no treatment period in treatment group [(1.2 +/- 0.3) h] was significantly shorter than that in control group [(2.8 +/- 0.5) h, (P < 0.01)]. The mortality rate in treatment group was 6.32% while that in control group 22.5% (P < 0.01). The incidence of respiratory failure, heart injury, brain injury, atropine poisoning, intermediate syndrome, liver injury in treatment group (12.64%, 5.75%, 8.62%, 1.72%, 4.60%, 5.17% respectively) were lower than those in control group (25.63%, 13.75%, 17.50%, 6.25%, 7.50%, 9.38% respectively, P < 0.05 or P < 0.01). The time of symptoms disappearance, the recovery time of AChE, atropinization time, atropine dosage, pralidoxime chloride dosage, naloxone dosage, hospitalization days in treatment group were significantly superior to those in control group (P < 0.05 or P < 0.01). CONCLUSION: The pre-hospital systematic treatment can improve the prognosis of the patients with SAOPP, which is worth popularizing and using.