急性敌敌畏中毒患者休克的临床特征及危险因素分析  

Analysis of clinical characteristics and risk factors of shock in patients with acute dichlorvos poisoning

作　　者：葛洪霞[1] 任珍 杨兴龙 李姝[1] 马青变[1] Ge Hongxia;Ren Zhen;Yang Xinglong;Li Shu;Ma Qingbian(Peking University Third Hospital,Beijing 100191,China;The Fifth Medical Center of the PLA General Hospital,Beijing 100039,China)

机构地区：[1]北京大学第三医院急诊科,北京100191 [2]解放军总医院第五医学中心,北京100039

出　　处：《中华急诊医学杂志》2024年第3期291-296,共6页Chinese Journal of Emergency Medicine

摘　　要：目的本研究旨在探讨急性敌敌畏中毒合并休克患者的临床特征,分析其危险因素。方法回顾分析2019年1月至2020年9月间北京大学第三医院和解放军总医院第五医学中心收治的急性敌敌畏中毒患者的临床资料,收集人口学资料、中毒情况、临床表现、化验检查、治疗措施及临床结局等,建立临床数据库。将患者分为两组:休克组和非休克组,比较两组间临床资料,分析急性敌敌畏中毒发生休克的临床特征和预后情况,采用Logistic回归分析急性敌敌畏中毒患者发生休克的危险因素。结果本研究共纳入符合标准的急性敌敌畏中毒患者134例,入院24 h内的休克发生率为39.6%(53/134),11例(8.21%)患者院内死亡,休克组患者的院内病死率高于非休克组(20.8%vs.0.0%,P<0.001)。相对于非休克组,休克组出现括约肌松弛症状、昏迷、低体温、脏器功能损伤更常见;患者的住院时间、住ICU时间、有创呼吸机使用时间更长。二元Logistic回归分析显示,有括约肌松弛表现(OR=10.888,95%CI:1.677~70.684,P=0.012)是急性敌敌畏中毒患者合并休克的独立危险因素,使用胆碱酯酶复能剂(OR=0.246,95%CI:0.072~0.846,P=0.026)是急性敌敌畏中毒患者合并休克的保护因素。结论急性敌敌畏中毒患者休克发病率较高且影响临床预后,有括约肌松弛表现、未使用胆碱酯酶复能剂是急性敌敌畏中毒患者合并休克的独立危险因素。Objective The aim of this study was to investigate the clinical characteristics and analyze the risk factors of patients with acute dichlorvos poisoning combined with shock.Methods The clinical data of patients with acute dichlorvos poisoning admitted to the Peking University Third Hospital and the Fifth Medical Center of the PLA General Hospital between January 2019 and September 2020 were retrospectively analyzed,and demographic data,poisoning,clinical manifestations,laboratory tests,therapeutic measures and clinical outcomes were collected to establish a clinical database.The patients were divided into two groups:the shock group and the non-shock group,and the clinical data were compared between the two groups to analyze the clinical characteristics and prognosis of shock in acute dichlorvos poisoning,and the risk factors of shock in acute dichlorvos poisoning were analyzed by logistic regression.Results A total of 134 patients who met the criteria for acute dichlorvos poisoning were included in this study;the incidence of shock within 24 hours of admission was 39.6%(53/134),and 11 patients(8.21%)died in hospital;the in-hospital morbidity and mortality rate of patients in the shock group was higher than that in the non-shock group(20.8%vs.0.0%,P<0.001).Symptoms of sphincter relaxation,coma,hypothermia,and organ function damage were more common in the shock group than in the non-shock group;and shock patients had longer hospitalization,ICU stay,and invasive ventilator use.Binary logistic regression analysis showed that the presence of sphincter relaxation manifestations(OR=10.888,95%CI:1.677-70.684,P=0.012)was an independent risk factor for comorbid shock in patients with acute dichlorvos poisoning,and the use of cholinesterase reanimators(OR=0.246,95%CI:0.072-0.846,P=0.026)was a protective factor for combined shock in patients with acute dichlorvos poisoning.Conclusions The incidence of shock in patients with acute dichlorvos poisoning is high and affects the clinical prognosis,and the presence of sphincter re

关 键 词：有机磷农药 急性敌敌畏中毒 休克 危险因素 预后 

分 类 号：R595.4[医药卫生—内科学]