大型综合性教学医院抢救室479例急性中毒的流行病学分析

Retrospective analysis of 479 poisoning cases in general teaching hospital

目的:了解大型综合性教学医院抢救室急性中毒的流行病学特点及治疗现状,以期对急性中毒的诊治和研究提供参考。方法:本研究回顾性分析2011-08-2015-07我院急诊抢救室登记的急性中毒患者的临床资料,包括性别、年龄、毒物种类、中毒方式、中毒原因、就诊时间、洗胃时间、血液净化时间等。结果:共纳入479例急性中毒患者,197例(41.13%)为男性,平均年龄(41.59±19.10)岁,女性282例(58.87%),平均年龄(40.04±17.42)岁,男女之比1∶1.43。无论男女,各年龄段的人数分布趋势基本一致,中毒人数均在20~29岁达高峰,30~39岁次之。毒物种类共66种,4年间仅出现1次的毒物32种。各类中毒以农药中毒272例(56.79%)位居第1,其次是药物中毒118例(24.63%)。单一毒物中毒439例(91.65%),混合毒物中毒33例(6.89%)。排名前3位的依次为百草枯157例(32.78%)、有机磷78例(16.28%)、镇静催眠药59例(11.69%)。急性中毒的方式以消化道摄入为主,437例(91.23%)。自杀是中毒的主要原因,416例(86.85%)。急性中毒以秋季发病最多,冬季发病最少。入院后予以洗胃366例(83.75%),其中发病1h以内实施洗胃156例(42.62%),1~6h洗胃174例(47.54%),>6h洗胃的36例(9.84%)。实施血液净化135例(27.61%),其中86.67%为农药中毒,75例(55.56%)于发病6h后实施血液净化。同时行洗胃及血液净化的128例(26.72%),该组患者发病至洗胃时间为(3.41±6.16)h,发病至血液净化的平均时间长达(8.28±7.23)h,血液净化比洗胃平均延迟(4.92±4.01)h。患者转归:144例(30.06%)患者在抢救室治疗无望后自动出院。294例(61.38%)患者在抢救室初步处理后转入急诊的各个区继续治疗,仅有3例患者收住其他专科继续治疗。结论:本研究为单中心回顾性研究,不具有广泛的代表性。但本研究的急性中毒流行病学资料及洗胃和血液净化的临床资料对本地区急性中毒防治及优化提供了一定的参考依据。

Objective：To assess epidemiological characteristics and treatment status of patients presenting in our comprehensive hospital＇s emergency department with acute poisoning,with a view to provide references for the diagnosis and treatment of acute poisoning. Method： This was a retrospective study to analyze the clinical data of all poisoning cases,it was recorded in First Aid Room of our hospital records from August 2011 to July 2015 ,clinical data including age,sex,type of poisons, cause and pathway of intoxication, the time from onset to gastric lavage, blood purification time,etc. Result：A total of 479 poisoning cases were reviewed. There was a predominance of fe- male patients （58.87%） with mean age （40.04!17.42） years compared to male patients （41. 130） with mean age （41.59~19.10） years. The ratio was 1.43 ： 1. There were 66 species of poison in total and 32 species of poi- son only occurred once in 4 years. 272 cases （56.79%） of pesticide poisoning were ranked first,followed by drug poisoning in 118 cases （24.63%）. Poisonings occurred with a single agent in 91.65% of cases and with two or more agents in 6.89% of cases. Most poisonings occurred in the age range of 20-29 years followed by 30-39 years. Paraquats were the most common cause of poisonings （32.7 %） followed by organophosphates （ 16.28 %） and benzodiazepines （11.69 %）. The common route of exposure to poisonous was gastrointestinal tract intake with rate of 91. 23%. Suicide is the main cause of poisoning,416 cases （86.85%）. The seasonal distribution in poisoning patients suggested a peak in autumn and a valley in winter. A total of 366（83.75%） patients treated with gastriclavage,in 1 h after onset was 42.62%,1-6 h was 47.54% and 6 h later was 9.84%,respectively. A total of 135 （26.72%） patients treated with blood purification,of which 86.67% were pesticide poisoning, Among them,75 patients were treated in 6 h later after onset. A total of 128（26.72%） patients were treated with both blood purifi- cation and gastric lavage, and the average time from onset to blood purification was 8.28±7.23 h,and the average time from onset to gastric lavage was （3.41±6.16） h,and the average time from gastric lavage to blood purifica- tion was （4.92±4.01） h. Conclusion：This was a university hospital-based study,so these results may not be rep- resentative of the general population. Despite this drawback,these data still provide important information on the characteristics of acute poisoning and the clinical therapy features, and offer scientific basis for prevention and treatment on acute poisoning in this region.