重症有机磷农药中毒早期并发多脏器功能障碍综合征临床分析

目的探索重症急性有机磷农药中毒（intensive acute organic phosphorus pesticides poisoning,I AOPP）患者早期并发多脏器功能障碍综合征（MODS）的临床特点及不同处理方式对预后的影响。方法回顾性分析2000年1月-2010年6月分别收治的I AOPP患者86例及103例,前者为A组,后者为B组。对年龄、性别、APACHEⅡ评分以及是否伴有休克、脑水肿、低氧血症、肺部感染等因素进行比较。同时也分析不同临床处理方式对I AOPP病死率的影响。结果 A组（n=86）和B组（n=103）中分别有21例和32例I AOPP早期并发MODS,MODS组和无MODS组二组比较APACHEⅡ评分,差异有统计学意义（P〈0.05）。MODS组休克、脑水肿、呼吸衰竭、肺部感染、低氧血症高于无MODS组,二组比较,差异有统计学意义（P〈0.01）。B组患者由于采用了综合性救治技术（如床边血滤、机械通气）以及早期反复洗胃,其病死率下降与A组比较,差异有统计学意义（P〈0.05）。结论 I AOPP患者早期并发MODS与休克、休克纠正是否及时、呼吸衰竭、肺部感染、低氧血症、脑水肿以及临床处理方式有关,及时有效的治疗可大大降低MODS的发生率。

CLINICAL ANALYSIS OF IAOPP COMPLICATED WITH MODS IN THE EARLY STAGE

Objective To study clinical characteristics of IAOPP complicated with MODS at the early stage and the affection of different treatments on prognosis.Methods 86 IAOPP patients served as A group,who admitted from January 2000 to December 2006;103 IAOPP patients served as B group,who admitted from January 2007 to June 2010;Age,sex,APACHEⅡ,shock,hypoxia,cerebral edema,lung infection etc.were analyzed.Influents on the fatality rate were also analyzed with different clinical processing modes.Results 21 in A group（n=86）and 32 in B group（n=103）were complicated with MODS at the early stage.There existed difference in APACHEⅡ,between patients with and without MODS（P0.05）.Shock,cerebral edema,hypoxia,etc.were more severe in patients with MODS（P0.01）.Fatality in B group was decreased because of receiving such therapy as bedside CBP,machinery ventilation.Because B group of patients used the comprehensive treatment technology（for example bedside blood to filter,machinery ventilation）as well as the early repeatedly gastric lavage,its fatality rate was lower than A group,the difference had the significance（P0.05）.Conclusion Hypoxia,lung infection,shock,cerebral edema and clinical treatments are connected with IAOPP complicated with MODS at the early stage.The incidence rate of MODS can be reduced by effective treatment.