有机磷农药中毒患者胃肠黏膜pH值监测

Change of Gastric Intramucosal pH in Acute Organophosphorus Poisoning

目的探讨急性有机磷农药中毒(AOPP)患者胃粘膜pH值(pHi)的变化特点及意义。方法对108例AOPP患者,按病情分为中、重度两组,入院后即刻经鼻放置张力计导管动态测定pHi,同时观察pHa、PaO2/FiO2的变化。结果两组入院时pHa、PaO2/FiO2均无异常,但24h～48h后重度中毒pHi较入科即刻明显下降,同期中度中毒组及其它氧合指标均无明显变化,与重度中毒组比较差异显著(P<0.01);随着病情的进展,两组共并发MODS30例,在24h～72hpHi均已明显降低(pHi均<7.32),而同时刻pHa、PaO2/FiO2却无显著降低。结论危重患者pHi监测较常规全身氧合指标敏感,有助于早期病情判断、预后评估及指导治疗。

Objective To explore the changes of gastric intramucosal pH(pHi) in acute organophosphorus pesticide poisoning(AOPP) patients.Methods 108 cases with AOPP were divided into two groups according to patients' conditions:median group and serious group.Atonometer nasogastric tube was immediately positioned in stomach to measure pHi and simultaneously investigate the change of pHa and PaO 2/FiO 2.Results There was no difference in the immediate pHi and PaO 2/FiO 2 between two groups.The pHi 24h^48h later in the serious group was far lower than that of immediate.At the same time the level of other oxygenation index are not significant change in the median group but it is significant to compare with serious group(P<0.01).With development of disease,30 cases appeared MODS(>7.32) and their pHi decrease sharply in 24h^72h however,the level of pHa and PaO 2/FiO 2 didn't decrease.Conclusion The monitoring of pHi in critical patients is more sensitive than systemic oxygenation index.The pHi is helpful to early judgements and therapy.