294例急性中毒接受洗胃患者的临床特征分析

Analysis of clinical characteristics of 294 acute poisoning patients with gastric lavage

目的通过分析南京医科大学第一附属医院急诊中心收治的294例洗胃患者的临床特征,描述急性中毒洗胃操作的现状并提出改进措施。方法收集2019年1月1日至2021年12月31日就诊的294例急性中毒洗胃患者的临床资料进行回顾性分析,并进行各年之间的相关参数(毒物种类、洗胃量、中毒至洗胃时间等)比较。结果2019年至2021年共653例急性中毒患者,294人进行洗胃,年龄(44.2±20.1)岁,男性134人(45.6%)。进行洗胃的主要原因为农药中毒(52.72%)、药物中毒(42.86%)。43.8%的患者洗胃量在10 L以内、32.7%的患者在10~20 L。摄入毒物后60 min内洗胃患者占45.3%,其次为61~120 min占25.8%。在院病死率17.7%。洗胃常见并发症:消化道出血(55/121)发生率45.5%,吸入性肺炎(54/140)发生率38.6%,电解质紊乱发生率分别为低钾20.1%、低钙28.2%、低钠9.2%。各年份组间比较发现,洗胃人数占中毒人数的比例为58.85%vs.46.60%vs.32.41%,呈逐年下降趋势,差异有统计学意义(P<0.01);洗胃时间和洗胃液量差异无统计学意义,毒物种类上敌草快和其他类杀虫剂有增加趋势,但差异无统计学意义。结论2019—2021年急性中毒洗胃主要原因是农药中毒和药物中毒,敌草快及其他杀虫剂占比总体呈上升趋势。71.1%的患者在2 h内洗胃,76.5%患者洗胃液量在20 L内。未来将进一步研究控制洗胃液量的临床意义、关注新型杀虫剂中毒的洗胃操作。

Objective To describe the current situation of gastric lavage operation and put forward measures for improvement by analyzing the clinical characteristics of 294 patients with gastric lavage in Poisoning Treatment Center of The First Affiliated Hospital of Nanjing Medical University.Methods The clinical data of 294 patients with acute poisoning and gastric lavage from 2019 to 2021 were collected and analyzed retrospectively,and the related parameters(poison type,gastric lavage volume,poisoning to gastric lavage time,etc.)of each year were compared.Results A total of 653 poisoning patients underwent gastric lavage from 2019 to 2021,with an average age of(44.2±20.1)years,and 134(45.6%)were male.The main causes of gastric lavage were pesticide poisoning(52.72%)and drug poisoning(42.86%).The volume of gastric lavage was less than 10 L for 43.8%of patients and 10-20 L for 32.7%of patients.Patients with gastric lavage within 60 min after ingestion of poison accounted for 45.3%,followed by 25.8%within 61-120 min.The in-hospital mortality rate was 17.7%.The common complications of gastric lavage were:the incidence of gastrointestinal bleeding(55/121,45.5%),the incidence of aspiration pneumonia(54/140,38.6%),and the incidences of electrolyte disorder(21%of low potassium,29%low calcium,and 10.0%low sodium).Compared with the groups in different years,the proportion of gastric lavage in poisoning was 58.85%vs.46.60%vs.32.41%,which decreased year by year,with statistical difference(P<0.05).And there was no difference in the period from ingestion to gastric lavage and gastric lavage fluid volume.There was an increasing trend in poison types between diquat and other insecticides,but there was no statistical difference.Conclusions From 2019 to 2021,the most common causes of acute gastric lavage were pesticide poisoning and drug poisoning,and the proportion of diquat and other pesticides showed an overall upward trend.A majority of the patients(71.1%)had gastric lavage within 2 h,and 76.5%of the patients had less than 20 L gastric lavage fluid.In the future,we will further control the amount of gastric lavage fluid and pay attention to the gastric lavage operation of new insecticide poisoning.