急性有机磷农药中毒住院患者的临床特征分析

Analysis of clinical characteristics of hospitalized patients with acute organophosphorus pesticide poisoning

目的了解博山地区急性有机磷农药中毒住院患者的流行病学特征,为博山地区急性有机磷农药中毒的防治提供科学依据。方法回顾性分析2012年1月至2018年12月博山区三甲医院救治的87例急性有机磷农药中毒住院患者的临床资料,分析有机磷农药中毒住院患者的临床特征。结果87例患者中,2012年度14例(16.09%),2013年度16例(18.39%),2014年度10例(11.49%),2015年度17例(19.54%),2016年度16例(18.39%),2017年度3例(3.45%),2018年度11例(11.49%);男28例,女59例;年龄(51.76±15.81)岁;累计月分布5月、7月份最多(31.03%);除不详29例及1例清水勾兑500 ml外,平均服药量(136.93±73.73)ml;服毒原因:1例生产性中毒(喷洒),86例生活性中毒均为自服(自杀),以敌敌畏为主(78.16%);院外时间(5.00±5.34)h。入院方式以呼叫“120”救护组占72.41%;56例患者有既往史;87例均给予洗胃、药物治疗;82例给予血液灌流;12例给予呼吸机治疗;转归:治愈3例,好转53例,自动出院14例,未愈14例,死亡3例,病死率为3.45%,住院时间(6.22±4.83)d。非生产性中毒以40岁以上已婚、远城区、农民及无业人员为主,100%为口服自杀,年龄分布、地域分布、服药量、胆碱酯酶活力等指标对患者转归差异有统计学意义(P<0.05)。结论博山区急性有机磷农药中毒住院患者有下降趋势,女性多于男性,以高毒类自服敌敌畏为主,工作防治的重点为中老年人群,特别是远城区的农民及无业人员,建议开展社区心理咨询及有机磷农药毒性危害教育,提升心理接受能力;加大院前急救的宣传力度,使患者得到及时治疗。

Objective To investigate the epidemiological characteristics of acute organophosphorus pesticide poisoning in Boshan district and provide scientific basis for the prevention and treatment of acute organophosphorus pesticide poisoning in Boshan district.Methods The clinical data of 87 hospitalized patients with acute organophosphorus pesticide poisoning treated in the third-grade A hospital of Boshan district from January 2012 to December 2018 were retrospective analyzed,the clinical characteristics of hospitalized patients with organophosphorus pesticide poisoning were analyzed.Results Among the 87 cases of poisoning,there were 14 cases(16.09%)in 2012,16 cases(18.39%)in 2013,10 cases(11.49%)in 2014,17 cases(19.54%)in 2015,16 cases(18.39%)in 2016,3 cases(3.45%)in 2017,11 cases(11.49%)in 2018;28 males and 59 females;age(51.76±15.81)years.The accumulative monthly distribution was at most(31.03%)in May and July.The average dosage of poison was(136.93±73.73)ml except for unknown 29 cases and 1 case mixed with 500 ml of water.Reasons for taking poison:1 case of productive poisoning(spraying),all the 86 cases of life poisoning were self-administered(suicide),and the majority were dichlorvos(78.16%),time out of hospital was(5.00±5.34)h.Call"120"ambulance team accounted for 72.41%;56 patients had previous medical history;87 cases were treated with gastric lavage and drug therapy;82 cases were given hemoperfusion;12 cases were treated with ventilator.Outcome:3 cases were cured,53 cases were improved,14 cases were discharged automatically,14 cases were not cured,3 cases died,the mortality rate was 3.45%,the length of hospitalization time was(6.22±4.83)d.Non-productive poisoning was mainly caused by married people over 40 years old,remote urban areas,farmers and unemployed people,and 100%of the cases were oral suicides.The age distribution,regional distribution,amount of medication,cholinesterase activity and other indicators had statistical significance on the outcome of patients.Conclusion Boshan area there is a downturn in hospitalized patients with acute organophosphorus pesticide poisoning,more women than men,and give priority to with high toxic class since taking dichlorvos,the prevention and control of work should focus on the middle-aged and old people,especially the farmers and unemployed far city,Suggestions to carry out the community psychological counseling and organophosphorus pesticide toxicity hazard education,promote psychological accept ability;Strengthen the publicity of pre-hospital first aid,so that patients get timely treatment.