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目的探索重症急性有机磷农药中毒(intensive acute organic phosphorus pesticides poisoning,I AOPP)患者早期并发多脏器功能障碍综合征(MODS)的临床特点及不同处理方式对预后的影响。方法回顾性分析2000年1月-2010年6月分别收治的I AOPP患者86例及103例,前者为A组,后者为B组。对年龄、性别、APACHEⅡ评分以及是否伴有休克、脑水肿、低氧血症、肺部感染等因素进行比较。同时也分析不同临床处理方式对I AOPP病死率的影响。结果 A组(n=86)和B组(n=103)中分别有21例和32例I AOPP早期并发MODS,MODS组和无MODS组二组比较APACHEⅡ评分,差异有统计学意义(P<0.05)。MODS组休克、脑水肿、呼吸衰竭、肺部感染、低氧血症高于无MODS组,二组比较,差异有统计学意义(P<0.01)。B组患者由于采用了综合性救治技术(如床边血滤、机械通气)以及早期反复洗胃,其病死率下降与A组比较,差异有统计学意义(P<0.05)。结论 I AOPP患者早期并发MODS与休克、休克纠正是否及时、呼吸衰竭、肺部感染、低氧血症、脑水肿以及临床处理方式有关,及时有效的治疗可大大降低MODS的发生率。
Objective To explore the clinical characteristics of early complicated multiple organ dysfunction syndrome (MODS) in patients with severe acute organic phosphorus pesticides poisoning (IOPOP) and the effect of different treatment methods on the prognosis. Methods A retrospective analysis of 86 cases and 103 cases of IOPP treated in our hospital from January 2000 to June 2010 was performed. The former is group A and the latter is group B. Age, gender, APACHE Ⅱ score and whether accompanied by shock, cerebral edema, hypoxemia, lung infection and other factors were compared. At the same time also analyzed the different clinical treatment of IOPOPC mortality. Results There were 21 cases in group A (n = 86) and group B (n = 103), 32 cases in early stage of AOPP complicated with MODS, MODS group and no MODS group. The difference was statistically significant (P < 0.05). MODS group, shock, cerebral edema, respiratory failure, lung infection, hypoxemia than in MODS group, the two groups, the difference was statistically significant (P <0.01). The mortality of group B was significantly lower than that of group A (P <0.05) due to the comprehensive treatment techniques (such as bedside blood filtration, mechanical ventilation) and early gastric lavage. Conclusion I AOPP patients with early complicated with MODS and shock, shock correction is timely, respiratory failure, pulmonary infection, hypoxia, cerebral edema and clinical treatment related, timely and effective treatment can greatly reduce the incidence of MODS.