2008—2009年华北四家医院急性农药中毒特征及死亡预后因素分析

Analysis on feature and prognostic factor of death of acute pesticide intoxication from four general hospitals in North China during 2008 to 2009

目的分析急性农药中毒病例的流行病学特征,了解影响预后的危险因素,探讨其发病规律及可行的防治策略。方法收集华北地区4家综合性医院2008年12月～2009年12月期间的306例急性农药中毒病例;采用自行设计的调查表,调查各个病例的一般资料、院前急救情况、症状、体征、实验室检查、预后等。结果 306例患者中,有机磷中毒173例(56.5%)、拟除虫菊酯中毒49例(16.0%)、百草枯中毒81例(26.5%)、其他中毒3例(1.0%);毒物89.5%主要经口吸收,多数发生在夏季,百草枯中毒程度最为严重,而拟除虫菊酯中毒较轻;预后,76.8%好转,18.6%死亡,其中百草枯中毒死亡比例高达40.7%;影响预后的因素包括性别(OR=3.930)、中毒程度(OR=10.166)、毒物种类(OR=5.854)、氧气吸入(OR=0.211)、呼吸系统(OR=6.180)、发热(OR=7.182)、心率(OR=4.063)、肾功能(OR=4.670)、心电图(OR=2.272)等指标。结论急性农药中毒与多种主观、客观因素有关。

Objective To analyze the epidemiological feature of acute pesticide intoxication, find out the risk factor affect- ed its prognosis, thereby clarify its regular pattern and feasible control measures. Methods Collect the data of 306 cases of actue pesticide intoxication from four general hospitals in North China area during December 2008 to December 2009, investigate the general data, pre-hospital care, sysmptoms, signs, laboratory indices, and prognosis using self-designed questionnaire. Results In 306 poisoned cases, 173 cases （56. 5% ） were by orgnaophosphorus, 49 cases （ 16.0% ） by pyrethroid and 81 cases （26. 5% ） by paraquat. The mainly （ 89. 5% ） invasion way was by mouth, majority of them happened in smmner; paraquat poisoning was most severe, while pyrethroid poisoning was the slightest. Of all cases, 76. 8% improved well, 18.6% died as contrast, 40. 7% of paraquat poisoning cases were died. The ma^n impact factors of prognosis in acute pesticide intoxica- tion including sex （ OR = 3. 930）, poisoning extent （ OR = 10. 166）, poison types （ OR = 5. 854 ）, oxygen therapy （ OR = 0.211 ）, respiratory system abnormality （ OR = 6. 180）, fever （ OR = 7. 182）, pulse （ OR = 4. 063 ）, renal function （ OR = 4. 670）, electrocardiography （ OR = 2. 272）, and so on. Conclusion The prognosis of acute pesticide poisoning is associat- ed with a variety of subjective and objective factors.