急性有机磷农药中毒患者血糖水平与脏器损伤病情严重程度及预后的相关性研究

Study on correlation between blood glucose levels and multiple organ injuries,degrees and prognosis of illness in AOPP

目的探讨急性有机磷农药中毒（AOPP）患者血糖水平与脏器损伤、病情严重程度及预后的相关性。方法选择76例AOPP患者，监测其住院第1、3、5天血糖、胆碱酯酶、各脏器功能损伤情况及预后，根据入院当天静脉血糖水平分为A组（血糖3、9～6．1mmoL／L）18例、B组（血糖6．1～11．12mmoL／L）42例和C组（血糖〉11．12mmoL／L）16例，以APACHEⅡ评分为标准，分析A、B、C组血糖水平与脏器功能损伤、病情严重程度及预后的关系。结果C组APACHEⅡ评分、CK-MB水平、AMS水平均较A组明显升高（P〈0．05），C组第1、3天CHE水平较A组明显降低（P〈0．05），C组ALT水平较A组明显降低；B组CHE水平较A组明显降低（P〈0．01），APACHEⅡ评分虽有升高，但差异无统计学意义；Kendall等级相关分析结果显示，血糖水平与呼吸衰竭、脑损伤（昏迷）、胰腺损伤、消化道出血、死亡均呈正相关（P〈0．05），而与肝脏损伤呈负相关（P〈0．05）；Pearson相关分析显示，血糖水平与APACHE11评分、CK-MB、CREA和AMS均呈正相关（P〈0．05，P〈0．01），与CHE、ALT呈负相关（P〈0．05）。结论AOPP患者血糖水平与脏器损伤、病情严重程度及预后密切相关。

Objective To investigate the correlation between blood glucose levels and multiple organ injuries, degrees and prognosis of illness in the patients with acute organophosphorus pesticide poisoning （AOPP）. Methods According to blood glucose levels, 76 patients with AOPP were divided into three groups： group A（n = 18） , blood glucose levels ranged from 3.9 mmol/L to 6.1 mmol/L; group B （n =42）, blood glucose levels ranged from 6. 1 mmol/L to 11.12 mmol/L; group C（n = 16）, blood glucose levels 〉 11.12 mmol/L. The blood glucose, ChE, multiple organ injuries and prognosis were ob- served on 1st, 3rd, 5th day. Finally, the correlation between blood glucose and multiple organ injuries, degrees of illness, prognosis of the three groups according to APACHE Ⅱ were analyzed. Results In group C, the level of APACHE Ⅱ, CK - MB, AMS were significantly higher than those in group A （ P 〈 0.05） , ChEs were lower than those in group A on 1st, 3rd day （P〈0.05） , and the levels of ALT decreased significantly in group C; Compared with group A, the levels of ChE decreased significantly （ P 〈 0.01 ） , but the increase of APACHE Ⅱ was not significant in group B. On the basis of Kendall correlation analysis, there were positive correlations between the blood glucose level and respiratory failure, brain damage （coma） , pancreas injury, digestive tract bleeding, death （ P 〈 0.05 ） , meanwhile, there were negative correlations between blood glucose and liver injury （ P 〈 0.05 ）. There were positive correlation between the blood glucose level and APACHE, CK - MB, CREA and AMS （ P 〈 0.05 or P 〈 0.01 ） , and there were negative correlation between the level of blood glucose and ChE, ALT （ P 〈 0.05 ） according to Pearson correlation analysis. Conclusion The blood glucose levels of the patients with AOPP closely associated with multiple organ injuries, degrees and prognosis of the illness.