不同时机行气管切开对急性有机磷中毒中间综合征患者的临床对比分析  

Clinical analysis of different timing of tracheotomy in patients with acute organophosphate poisoning intermediate syndrome

作　　者：张翼 

机构地区：[1]陆军军医大学西南医院急救部,重庆400030

出　　处：《临床急诊杂志》2017年第12期899-901,906,共4页Journal of Clinical Emergency

摘　　要：目的:探讨不同时机行气管切开对急性有机磷中毒中间综合征患者的临床效果。方法:选取2014-01-2016-12期间收治的62例患有急性有机磷中毒中间综合征患者展开研究。将入选研究对象随机分成对照组(32例)、观察组(30例)。两组患者均接受气管插管治疗,根据患者具体病情合理选择呼吸机模式和参数,对照组患者呼吸机撤机拔管不可能时行气管切开,观察组患者在患者插管后24h内行气管切开,比较两组患者的临床效果、各项手术指标、APACHEⅡ评分以及GCS评分。结果:观察组患者治疗后的治愈率(93.33%)显著高于对照组(68.75%),与之对应的死亡率(6.67%)则显著低于对照组(31.25%),比较差异有统计学意义(P<0.05);观察组患者肺部感染率和中毒反跳率(6.67%、0)显著低于对照组(28.13%、15.63%),比较差异有统计学意义(P<0.05);观察组患者的阿托品总用量[(175.81±14.20)mg]显著少于对照组[(214.52±22.47)mg],且观察组阿托品化时间、意识恢复时间、胆碱酯酶活性恢复时间、机械通气时间以及住院时间[(2.72±0.44)h、(2.72±0.44)h、(7.97±1.45)d、(7.60±0.86)d、(7.60±0.86)d]均短于对照组[(3.61±1.03)h、(4.57±1.10)h、(9.26±1.58)d、(10.35±1.61)d、(20.36±1.98)d],比较差异有统计学意义(P<0.05);观察组患者抢救成功后的APACHEⅡ评分[(15.67±2.20)分]明显低于对照组患者[(22.82±3.24)分],对比差异有统计学意义(P<0.05);观察组患者抢救成功后的GCS评分[(13.60±2.45)分]明显高于对照组患者[(10.07±1.51)分],对比差异有统计学意义(P<0.05)。结论:急性有机磷中毒中间综合征患者尽早行器官切开有助于降低病死率和感染、中毒反跳等并发症发生,且可促进患者预后康复,改善APACHEⅡ和GCS评分,值得推广应用。Objective：To investigate the clinical effect of tracheotomy in different timing on patients with intermediate syndrome of acute organophosphate poisoning.Method：Totally 62 patients with intermediate syndrome of acute organophosphate poisoning were enrolled in the study from January 2014 to December 2016.The selected subjects were randomly divided into control group（32 cases）and observation group（30 cases）.According to the specific conditions of patients,both groups received endotracheal intubation with reasonable choices of ventilator mode and parameters.The patients in the observation group received tracheotomies within 24 hours after intubation,while the patients in the control group had tracheotomies only when there was no chance to wean ventilators.The clinical effects,various surgical indicators,APACHEⅡ score and GCS score were compared between the two groups.Result：The cure rate（96.67%）in the observation group was significantly higher than that in the control group（78.13%）and the corresponding mortality rate（3.33%）was significantly lower than that in the control group（21.87%）,the difference was statistically significant（P〈0.05）.The lung infection rate and poisoning rate（6.67%,0）in the observation group were significantly lower than those in the control group（28.13%,15.63%）,the difference was statistically significant（P〈0.05）.The total amount of atropine used in the observation group（175.81±14.20）mg was significantly less than that of the control group（214.52±22.47）mg,meanwhile the observation group＇s atropisol time,consciousness recovery time,recovery time of cholinesterase activity,duration of mechanical ventilation and hospital stay（2.72±0.44 h,2.72±0.44 h,7.97±1.45 d,7.60±0.86 d,7.60±0.86 d）were significantly shorter than those in the control group（3.61±1.03 h,4.57±1.10 h,9.26±1.58 d,10.35±1.61 dand 20.36±1.98 d）,the difference was statistically significant（P〈0.05）.The APACHEⅡ scores in the observation group（15.67

关 键 词：不同时机 气管切开 急性有机磷中毒 中间综合征 临床效果 

分 类 号：R825.92[医药卫生—临床医学]