GCS评分、APACHE Ⅱ评分及血清胆碱酯酶在评估急性重度有机磷农药中毒患者状态及预后中的的临床价值

Clinical value of GCS score,APACHEⅡ score and serum cholinesterase in evaluating status and prognosis of patients with acute severe organophosphorus pesticide poisoning

目的分析格拉斯哥昏迷指数(GCS)评分、急性生理和慢性健康状况Ⅱ(APACHEⅡ)评分和血清胆碱酯酶在评估急性重度有机磷农药中毒患者状态及预后中的临床价值。方法选择2013年5月—2017年5月解放军第180医院收治的150例急性有机磷农药中毒患者,依照患者临床资料,将患者分为重度患者组(n=49)、中度患者组(n=47)和轻度患者组(n=54),比较3组患者血清中胆碱酯酶、血糖、肌酐和丙氨酸氨基转移酶水平,GCS评分与APACHEⅡ评分,并分析两种评分和血清胆碱酯酶与死亡相关性。结果3组患者服用高毒类有机磷农药比例越大、服毒量越多、服毒至急救时间越长,中毒越严重,且3组两两比较差异均有统计学意义(均P<0.05)。随中毒程度加重,3组患者血清中胆碱酯酶水平下降,血糖、肌酐和丙氨酸氨基转移酶水平上升,3组两两比较差异有统计学意义(P<0.05)。患者中毒程度越重,GCS评分越低和APACHEⅡ评分越高,每两组比较差异均有统计学意义(均P<0.05);GCS评分与急性有机磷农药中毒死亡呈负相关性(r=-0.2132,P<0.05),APACHEⅡ评分、血清胆碱酯酶与急性有机磷农药中毒死亡呈正相关(r=0.321、0.446,均P<0.05)。结论GCS评分、APACHE-II评分以及血清胆碱酯酶能够较好反映急性重度有机磷农药中毒患者病情状态及死亡率评估,值得临床推广应用。

Objective To analyze the clinical value of Glasgow Coma Scale (GCS) score,Acute Physiology and Chronic Health EvaluationⅡ( APACHEⅡ)score and serum cholinesterase in evaluating the status and prognosis of patients with acute severe organophosphorus pesticide poisoning.Methods A total of 150 patients with acute organophosphorus pesticide poisoning,who were admitted to the No.180 Hospital of PLA during the period from May 2013 to May 2017,were enrolled in the study.According to the clinical data,the patients were divided into severe group(n=49),moderate group(n=47) and mild group(n=54).The levels of serum cholinesterase,blood glucose,creatinine and alanine aminotransferase,and GCS score,APACHE Ⅱ score were compared among the three groups.The relationship between the two scores,serum cholinesterase and death were analyzed.Results The higher the proportion of high-toxic organophosphorus pesticides,the more the amount of poison,the longer the first aid time was,the more severe the poisoning was,and the differences were statistically significant among three groups in multiple comparison (P<0.05). With the aggravation of poisoning degree,the levels of serum cholinesterase of the three groups decreased,and the levels of blood glucose,creatinine and alanine aminotransferase increased,and the differences were statistically significant among three groups in multiple comparison(P<0.05).The more severe the poisoning was,the lower the GCS score and the higher the APACHE Ⅱ score were,and the differences were statistically significant among three groups in multiple comparison (P<0.05).The death of acute organophosphorus pesticide poisoning was negatively correlated with GCS score (r=-0.213,P<0.05),and was positively with A-APACHE-Ⅱ score and serum cholinesterase(r=-0.321,0.446,P<0.05).Conclusion GCS score,APACHEⅡ score and serum cholinesterase can well reflect the condition and mortality rate of patients with acute severe organophosphorus pesticide poisoning, which is worthy of clinical popularization and application.