老年急性中毒患者临床特点和死亡危险因素分析

Analyses on relevant factors of the prognosis of elderly patients with acute poisoning

目的探讨老年急性中毒患者的临床特点及死亡危险因素，为提高老年中毒患者诊治水平提供依据。方法回顾性分析自2009年7月至2015年5月温州医科大学附属第一医院急诊科收治的177例老年急性中毒患者。根据患者治疗结果分为死亡组（31例）和存活组（146例），对两组患者临床资料，用logistic回归分析影响预后的相关因素。结果177例患者死亡31例（17.5%），存活146（82.5%）例，其中102例（57.6%）有慢性基础疾病。死亡组农药中毒28例，农药中毒病死率为23.5%。60~69岁组死亡率12.8%（11/86），70~79岁组20.0%（13/65），80~89岁组26.9%（7/26）。主要中毒原因为有意口服中毒（100例，56.5%）。中毒途径以消化道为主（148例，83.6%）。死亡组和存活组的PSS评分和APACHE-II评分分别为2.97±0.18、2.27±0.81和19.8±2.8、12.8±5.3。与存活组比较，死亡组农药中毒、消化道中毒、有意口服中毒所占比例、PSS评分、APACHE-II评分均明显升高，差异有统计学意义（P〈0.05）。毒物种类（农药与非农药）、PSS评分、APACHE-II评分是老年患者死亡的独立危险因素。结论老年急性中毒患者多数存在一种或多种慢性基础病，有意经消化道摄入、农药中毒较常见，总体病死率较非老年中毒病死率明显升高。毒物种类、PSS评分、APACHE-II评分是老年患者预后的影响因素。

ObjectiveTo explore the risk factors influencing the prognosis of elderly patients with acute poisoning.MethodsWe retrospected 177 elderly patients with Acute Poisoning who were treated in the emergency department of the first affiliated hospital of wenzhou medical university from July 2009 to May 2015. According to the outcome of patients, we distributed the patients to death group （31 cases） and survival group （146 cases） , compared the clinic data and using multivariate analysis with Logistic regression to prognosis factors.ResultsThere were 177 cases in total, with 146 survivors （82.5%） and 31 deaths （17.5%） . In which 102 cases （57.6%） had chronic underlying diseases. There were 28 cases of pesticide poisoning in the death group, and the fatality rate of pesticide poisoning was 23.5%. The mortality rate was 12.8% in the 60-69 years-old group （11/86） , 20% （13/65） in the 70-79 years-old group, 26.9% （7/26） in the 80-89 years-old group. The most common reason of poisoning was intentional ingestion, with 100 cases （56.5%） . The tract of the poisoning was mainly in digestive system, including 148 cases （83.6%） . The PSS score and APACHE-II score were 2.97±0.18 and 19.8±2.8 in the death group, 2.27±0.81 and 12.8±5.3 in the survival group. Compared with the survival group, poison （pesticides or non） 、poisoning route、cause of poisoning、PSS score、APACHEⅡ score have significant difference in death group （P〈0.05） . Poison （pesticides or non） 、PSS score、APACHEⅡ, were the independent risk factors of poor prognosis.ConclusionMost of the elderly patients with acute poisoning have one or more chronic underlying diseases, the digestive tract ingestion and pesticide poisoning are more common. The fatality rate of the old patients is significantly higher than that of non elderly poisoning. Type of toxications, PSS score and APACHE-II score are the prognostic factors in elderly patients.