老年重度有机磷农药中毒致多脏器损伤的早期综合治疗体会

Early Comprehensive Treatment Experience of Multiple Organ Damage of Elderly Severe Organophosphorus Pesticide Poisoning

目的探讨老年急性重度有机磷农药中毒(AOPP)致多脏器损伤的早期综合治疗的临床方法和效果。方法 58例老年重度AOPP患者,2014年1月至2016年4月收治的患者28例,按照传统的治疗方法,设为对照(A)组;2016年5月至2018年4月收治的患者30例,在中毒后24 h内积极采用早期综合治疗方案,设为治疗(B)组。检测两组患者入院后4 h、72 h、7 d后血清胆碱酯酶活力、肌酸激酶同工酶、肌钙蛋白I、丙氨酸氨基转移酶、尿素氮、肌酐、N末端BNP前体、高敏C反应蛋白、乳酸等的变化,观察患者并发急性呼吸窘迫综合征、心电图异常情况、多器官功能障碍综合征、住重症监护病房时间、病死率的情况。结果入院后4 h两组CHE下降,其余各项指标均升高,差异无显著性(P>0.05);治疗72 h后,A、B两组指标数值差异较大,组间差异有统计学意义(P<0.05);7 d后,B组部分指标先恢复到正常范围,组间差异有统计学意义(P<0.05);A组患者ARDS发生率、MODS发生率、心电图异常的比例、住ICU时间、病死率高于B组,差异有统计学意义(P<0.05)。结论早期积极采用综合治疗,对老年急性重度AOPP患者多脏器具有保护作用,能有效改善疾病预后,降低病死率。

Objective To investigate the clinical method and effect of early comprehensive treatment of multiple organ damage of elderly acute severeorganophosphorus pesticide poisoning.Methods 58 cases of elderly patients with severe AOPP,In January 2014-April 2016 treated 28 cases of patients,according to the traditional treatment,set as control group A.In may 2016-April 2018 treated 30 cases of patients,within 24 h after by poisoning the activeadoption of early comprehensive treatment,set as control group B.Detection of two groups of patients admitted to hospital after 4 h,72 h,7 d after the serumcholinesterase vigor,creatine kinase isoenzyme,troponin I,alanine aminotransferase,urea nitrogen,creatinine,N terminal BNP precursor,high-sensitivityc-reactive protein and the change of lactic acid,observe patients complicated with acute respiratory distress syndrome,electrocardiogram abnormalities,multiple organ dysfunction syndrome,live intensive care unit,the case fatality rate.Results 4 h after admission CHE decline in both groups,the rest of theindicators are rising,there was no significant difference(P>0.05);Treatment after 72 h,A,B two groups of index numerical difference is larger,differencebetween groups was statistically significant(P<0.05);After 7 days,group B part indicators to restore to the normal range,difference between groups wasstatistically significant(P<0.05);Group A with ARDS,MODS incidence,the proportion of abnormal ecg,ICU time,case fatality rate higher than that ofgroup B,the difference was statistically significant(P<0.05).Conclusions Early active adoption of comprehensive treatment of elderly patients with acutesevere AOPP multiple organ has a protective effect,can effectively improve the prognosis of disease,reduce the case fatality rate.