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目的:探究影响急性有机磷中毒合并中间综合征(IMS)预后的相关危险因素,为急性中重度有机磷患者的救治提供合理的临床指导。方法:回顾性分析2011年7月~2015年1月期间来我就诊52例急性有机磷中毒合并中间综合征患者,根据患者的生存情况分为死亡组19例,生存组33例,对比性分析两组患者的一般情况,急诊措施,临床检查指标等一系列资料。结果:利用Spass19.0对数据进行分析表明,两组患者的急性生理学与慢性健康状况评分(APACHEⅡ)存在显著性差异。生存组机械通气的方式,开始洗胃的时间,以及是否血液灌输与死亡组存在显著性差异。对血液检测指标的分析表明,生存组血清肌酸激酶(CK)和乳酸脱氢酶(LDH)水平明显低于死亡组,而HCO3-浓较死亡组相比稍偏高,均具有统计学显著性差异。多因素logistic回归分析表明开始洗胃时间,APACHEⅡ评分,血清CK及LDH水平急性有机磷中毒合并IMS预后的主要影响因素,并且APACHEⅡ评分和血清CK,LDH水平均呈正相关。结论:开始洗胃时间,机械通气方式,血液灌输等急救措施与急性有机磷中毒合并IMS的预后相关,尽早洗胃可以显著提高急性有机磷中毒合并IMS的生存机会,高水平的血清CK,LDH以及较高APACHEⅡ评分为急性有机磷中毒合并IMS预后的相关危险因素。
Objective: To explore the related risk factors affecting the prognosis of acute organophosphate poisoning combined with intermediate syndrome (IMS), and to provide reasonable clinical guidance for the treatment of patients with acute moderate-severe organophosphate. Methods: A retrospective analysis of 52 patients with acute organophosphate poisoning and intermediate syndrome who were treated in our hospital from July 2011 to January 2015 was divided into 19 death patients and 33 survival patients according to the patients’ survival. The comparative analysis Two groups of patients in general, emergency measures, clinical examination indicators and a series of data. Results: Analysis of the data using Spass 19.0 showed significant differences in the acute physiology and chronic health status scores (APACHE II) between the two groups. The means of mechanical ventilation in the survival group, the time to start the gastric lavage, and whether there was a significant difference between the blood infusion and death groups. Analysis of blood test indicators showed that serum creatine kinase (CK) and lactate dehydrogenase (LDH) levels in survival group were significantly lower than those in death group, while HCO3-concentration was slightly higher than that in death group, both of which were statistically significant Sex differences. Multivariate logistic regression analysis showed that the main factors influencing the prognosis of acute organophosphate poisoning combined with APACHEⅡscore, serum CK and LDH levels were the main factors influencing prognosis of gastric cancer, and APACHEⅡscore and serum CK and LDH levels were positively correlated. Conclusion: The first aid measures such as lavage time, mechanical ventilation and blood infusion are related to the prognosis of acute organophosphate poisoning combined with IMS. As soon as possible gastric lavage can significantly improve the survival chance of acute organophosphate poisoning combined with IMS, and high levels of serum CK, LDH And the higher APACHEⅡscores were related risk factors of acute organophosphate poisoning combined with the prognosis of IMS.