急性百草枯中毒致多器官功能障碍综合征的临床分析  

Clinical analysis of multiple organ dysfunction syndrome caused by acute paraquat poisoning

作　　者：史晶[1] 高渝峰[1] 黄澎[1] 曾润生[1] 

机构地区：[1]广州市第十二人民医院 广州市化学中毒救援中心急诊科,510620

出　　处：《中华劳动卫生职业病杂志》2011年第7期519-521,共3页Chinese Journal of Industrial Hygiene and Occupational Diseases

基　　金：广东省医学科研基金（2010501）;广州市医药卫生科技项目（2009-YB-111）

摘　　要：目的 探讨急性百草枯中毒致多器官功能障碍综合征（MODS）的临床特点.方法 回顾分析2005年6月至2009年6月收治的68例口服百草枯中毒患者的临床资料,所有人选患者服毒到救治的时间均＜24 h,依据临床结局分为病死组37例和存活组31例,分析两组病例的服毒至就诊时间、服毒剂量、治疗5 d内MODS出现的时间以及受损器官数目.结果 68例患者中发生急性呼吸窘迫综合征（ARDS）35例,发生率为51.47%,急性肺损伤（ALI）的发生率为97.1%（66/68例）,中毒患者的病死率为54.4%（37/68例）.病死组患者服毒至就诊时间和服毒剂量明显高于存活组,差异有统计学意义（P＜0.05,P＜0.01）.病死组患者MODS器官数目＞3个的构成比（70.27%）明显高于存活组（38.71%）,差异有统计学意义（P＜0.01）,病死组患者MODS出现时间和ALI/ARDS出现时间,明显低于存活组,差异有统计学意义（P＜0.05）.百草枯中毒病例的中毒性心肌、肝、肾等损害较肺损伤出现早.结论 急性百草枯中毒导致的MODS出现时间早、病情凶险而且病死率高,以肺损伤为主的MODS是导致死亡的主要原因,服毒至就诊时间和中毒剂量是影响患者预后的重要因素之一.Objective To analysis clinical characteristics of the multiple organ dysfunction syndrome （MODS） caused by acute paraquat poisoning（APP）. Method Clinical data of 68 APP cases from Jan 2006 to Jun 2009, including age, gender, poisoning time and dosage, and MODS time, were compared in two groups, i.e.the death （37 cases） and survived （31 cases） groups. It was less than 24 hours from poisoning to rescue in all cases. Results Among the 68 cases, the incident rate of ARDS was 51.47% （35 cases）. The rate of acute lung injure was 97.1% （66 cases）. The mortality was 54.4% （37 cases）. There was no significant difference in age and gender between both groups （P〉0.05）. The dosages and times from poisoning to rescue were significant different between two groups （P〈0.05, P〈0.01）. In the death group, proportion of amounts （〉3） of organs related with MODS was 70.29%, which was significantly higher than that （38.71%） in survived group （P〈0.01）. MODS and ALI/ARDS occurred in death group earlier than those in survival group （P〈0.05）. On the other hand, cardiac, hepatic and renal damage occurred earlier than the lung injure. Conclusion MODS in APP patients occurred earlier, were more sever, and caused higher mortality. The poisoning dosage and time were important prognostic factors.

关 键 词：百草枯 中毒 多器官功能衰竭 呼吸窘迫综合征 

分 类 号：R686[医药卫生—骨科学]