有机磷中毒合并呼吸衰竭的危险因素分析

Analysis of risk-factors in acute organophosphorus poisoning with respiratory failure

目的分析探讨急性有机磷中毒（AOPP）患者并发呼吸衰竭的危险因素。方法对2000年以来我科收治的AOPP患者2 132例进行回顾性分析,其中合并呼吸衰竭患者207例（呼吸衰竭组）,随机抽取未发生呼吸衰竭的患者186例（对照组）,对血浆胆碱酯酶活力（AchE）等11项可能相关的危险因素采用logistic多变量逐步前向回归法分析发生呼吸衰竭的独立危险因素。结果 11项可能的相关危险因素中有6项指标差异有统计学意义（P〈0.05）,包括血乳酸（Lac）水平（OR=5.19,95%CI=3.14-10.37）、屈颈抬头无力（OR=12.14,95%CI=9.64-18.35）、AchE活力（OR=12.65,95%CI=9.51-19.96）、中毒至开始治疗时间（OR=8.38,95%CI=6.12-11.36）、肌酸激酶（CK）水平（OR=9.81,95%CI=6.58-13.31）、急性生理及慢性健康状况Ⅱ（APACHEⅡ）评分（OR=7.04,95%CI=4.93-11.30）。结论 AOPP患者易并发呼吸衰竭,AchE活力、屈颈抬头无力、CK水平、中毒至治疗开始时间、APACHEⅡ评分、血Lac水平是AOPP发生呼吸衰竭的独立危险因素。

Objective To analyze risk factors in acute organophosphorus poisoning（AOPP） with respiratory failure.Methods Retrospective analysis was done in 2 132 AOPP patients since 2000,207 cases who suffered from respiratory failure entered respiratory failure group,186 cases who did not occur respiratory failure entered control group.Analysis involved the related independent risk factors of 11 clinical factors according to multivariable logistic regression analysis method.Results Two groups had significant difference（P〈0.05） in following aspects as blood lactic acid level（OR=5.19,95%CI=3.14—10.37）,lifting head and shrugging weakness（OR=12.14,95%CI=9.64—18.35）,AchE（OR=12.65,95%CI=9.51—19.96）,treatment start time（OR=8.38,95%CI=6.12—11.36）,CK（OR=9.81,95%CI=6.58—13.31）,APACHEⅡ score（OR=7.04,95%CI=4.93—11.30）.Conclusion AOPP patients often suffer from respiratory failure,AchE,lifting head and shrugging weakness,CK level,treatment start time,APACHE Ⅱ score,blood lactic acid level are independent risk factors for respiratory failure.