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 risk factors affecting the prognosis of intermediate syndrome after acute organophos-phate poisoning, and to provide reasonable clinical guidance for treatment of acute organ phosphorus pesticide patients. Meth-ods Retrospective analyzed to 52 cases of acute organophosphate poisoning combined intermediate syndrome from July 2011 to January 2015 in my hospital. The pantients was divided into two groups: 19 cases for death and 33 cases for survival, compara-tive analysis the emergency measures, clinical examination and a series of indicator data of two groups patients. Results Re-sults showed that acute physiology and chronic health score (APACHEⅡ) was a significant difference between the two groups of patients. There were significant differences of time of gastric lavage, mechanical ventilation and blood infusion between the survival group and death group. Blood detection index showed that the serum CK and LDH levels of survival group were signifi-cantly lower than the death group, and HCO3-concentration slightly higher than the death group. Multivariate logistic regression analysis showed that the time of gastric lavage, APACHEⅡ score, serum CK and LDH level are the main factors affecting the prognosis of acute organophosphate poisoning combined IMS, and APACHEⅡ scores and serum CK, LDH levels were posi-tively correlated. Conclusion Time of gastricing lavage, mechanical ventilation and blood infusion are associated with the prog-nosis of acute organophosphate poisoning combined IMS, gastric lavage as early as possible can significantly improve poisoning of acute organophosphate combined IMS, and high levels of serum CK, LDH and APACHE score are the risk factors associated with acute organophosphate poisoning combined IMS pantients.
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