急性有机磷农药中毒致呼吸衰竭相关临床因素的探讨

Study on correlated clinical factors of respiratory failure induced by acute organophosphorus pesticide poisoning

目的探讨与急性有机磷农药中毒(AOPP)所致呼吸衰竭相关的临床因素,寻找防治呼吸衰竭的有效措施。方法重度AOPP患者34例,根据动脉血气分析结果分为呼吸衰竭组(A组,n=16)和非呼吸衰竭组(B组,n=18),观察呼吸衰竭发生的时间、次数、原因及上机时间,观察两组患者APACHEⅡ评分及脏器损伤个数、血糖及血浆胆碱酯酶的变化、胃管洗胃情况及住院期间阿托品应用总量的差异。结果AOPP致呼吸衰竭的原因依次为肺水肿、呼吸中枢衰竭、中间综合征及解毒剂过量;A组APACHEⅡ评分、脏器损伤个数及住院期间阿托品总量明显高于B组;A组入院胆碱酯酶水平明显低于B组;A组留置胃管间断洗胃的比例明显少于B组;相关分析显示,血糖与呼吸衰竭无相关性,而APACHEⅡ评分、脏器损伤个数、阿托品总量与呼吸衰竭呈正相关,胆碱酯酶水平与呼吸衰竭呈负相关。结论胆碱酯酶水平和APACHEⅡ评分均可反映AOPP的中毒程度,可用于AOPP患者呼吸衰竭的预测;洗胃机洗胃后再给予留置胃管洗胃是防治呼吸衰竭的有效措施;正确应用阿托品是防治呼吸衰竭的重要手段。

Objective To investigate the correlated clinical factors of respiratory failure induced by acute organophosphorus pesticide poisoning （ AOPP ）, and look for effective method for the prevention and treatment of respiratory failure. Methods 34 patients of severe AOPP were divided into respiratory failure group （ A group, n = 16 ） and non - respiratory failure group （ B group, n = 18 ） according to arterial blood gas analysis. The time, frequency and causes of respiratory failure were observed ; We also observed the differences of APACHEⅡ scores, the number of injured organs, and changes of blood glucose and cholinesterase in serum; Whether gastric lavage with tubes was carried out and a total dosage of atropine in the duration of hospitalization were also reviewed. Results The causes of respiratory failure induced by AOPP were lung edema, respiratory center failure, intermediate syndrome and overdose of antidotes in order;the APACHE Ⅱ scores, the number of injured organs and a total dosage of atropine in the duration of hospitalization of A group were more than that of B group obviously; the level of cholinesterase was lower in the A group; the ratio of gastric lavage with tubes in A group was less than that in B group; Correlation analysis showed that blood glucose had no correlation, the APACHEⅡ scores, the number of injured organs and a total dosage of atropine had positive correlation and the level of cholinesterase had negative correlation with respiratory failure induced by AOPP. Conclusion Both the level of cholinesterase and APACHE Ⅱ scores can reflect the degree of poisoning, which can be used for the prediction of respiratory failure induced by AOPP; gastric lavage with tubes after gastric lavage with machine is an effective method and correct use of atropine is an important way to prevent and treat respiratory failure induced by AOPP.