急性有机磷农药中毒脏器损害的分布和预后分析

目的：评价急性有机磷中毒脏器损害的分布以及与预后的关系。方法：对79例急性有机磷中毒作回顾性分析，根据临床和检验指标判断其脏器功能损伤的程度，并分析各系统脏器的损害与预后的关系。结果：急性有机磷中毒早期出现多脏器功能的损害，其分布情况除了肺水肿、脑水肿、呼吸衰竭和休克等并发症的发生率很高，恶性心律失常（20．52％）、急性上消化道出血（21．39％）和血尿（27．85％）及血尿素氮增高（31．65％）的发生率也较高。血尿素氮增高值呈一过性轻度改变。尚未发现有机磷农药直接造成急性肾功能衰竭的病例。个别病例出现肝损害（3．38％）和在恢复期出现严重的神经系统损害（2．52％）。肺水肿、脑水肿、呼吸衰竭争休克等并发症在生存组和死亡组之间差别有显著性之外，恶性心律失常和急性上消化道出血的发生率在生存组与死亡组的对比差别有显著性（P〈0．01和P〈0．05）。结论：急性有机磷中毒早期多脏器损害分布中恶性心律失常、急性上消化道出血和血尿也是频发的并发症，除了呼吸衰竭、脑水肿、肺水肿和休克等器官功能损害影响预后之外，心脏损害和急性胃粘膜病变，也是影响预后的严重并发症。虽然有机磷农药是从肝脏代谢、肾脏排泄和重吸收的，但其对肾功和肝功损害较轻，说明其急性期独立于神经作用之外的直接毒性作用较弱。

Organ Injury Resulted From Acute Organophosphorus Pesticide Poison and Its Prognosis

Objective: To evaluate the status of organs injury and prognosis in patients with acute organophosphorus pesticide poison(AOPP).Methods: Clinical data of 79 patients experienced AOPP were reviewed,and the organs injury function were determined according to clinical symptoms and laboratory data.And the relationship between organs injury and prognosis was analyzed.Results: The incidence of malignant arrhythmia(20.52%),acute upper gastrointestinal hemorrhage(21.39%),blood urine(27.85%)was higher as well as pulmonary edema,cerebral edema,respiratory failure and shock.No acute renal failure directly happened.The high incidences of malignant arrhythmia and acute upper gastrointestinal hemorrhage were observed in death group and there was a significant differences between death group and the survival groups(P<0.01),same as cerebral edema,pulmonary edema,respiratory failure and shock.Conclusion: The complications of AOPP in early mainly are arrhythmia,acute upper gastrointestinal hemorrhage and blood urine;the cerebral edema,pulmonary edema,respiratory failure and shock are the important factors affecting prognosis.Meanwhile,the results suggest that organophosphorus pesticide is metabolized in liver and evacuated and reabsorbed in kidney but no direct cytotoxicity injury is found but neurotoxicity in early.