急性有机磷农药中毒患者并发毛细血管渗漏综合征的危险因素分析  

Risk Factors of Capillary Leak Syndrome in Patients with Acute Organophosphorus Pesticide Poisoning

作　　者：韩旭 杨一红 姜辉[1,2] 刘业成 HAN Xu;YANG Yihong;JIANG Hui;LIU Yecheng(Department of Emergency,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;State Key Laboratory of Complex Severe and Rare Diseases,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;Department of Emergency,Fuyang People's Hospital,Fuyang,Anhui 236000,China)

机构地区：[1]中国医学科学院北京协和医院急诊科,北京100730 [2]中国医学科学院北京协和医院疑难重症及罕见病国家重点实验室,北京100730 [3]阜阳市人民医院急诊科,安徽阜阳236000

出　　处：《协和医学杂志》2024年第4期855-861,共7页Medical Journal of Peking Union Medical College Hospital

基　　金：阜阳市重点研究与开发计划临床医学研究转化项目(FYZDYF2023LCYX034)。

摘　　要：目的探索急性有机磷农药中毒(acute organophosphorus pesticide poisoning,AOPP)患者并发毛细血管渗漏综合征(capillary leak syndrome,CLS)的危险因素,为早期预防及诊断AOPP并发CLS提供参考。方法前瞻性收集2020年11月—2022年6月阜阳市人民医院急诊科连续收治的AOPP患者临床资料,包括临床表现、辅助检查及预后情况等,根据是否并发CLS将其分为CLS组和非CLS组。以患者入院为观察起点,以死亡或出院为观察终点,采用多因素Logistic回归分析探索AOPP并发CLS的危险因素。结果共纳入38例AOPP患者,其中17例(44.7%)并发CLS;非CLS组与CLS组患者在年龄(P=0.015)、敌敌畏血药浓度(P=0.001)、敌百虫血药浓度(P<0.001)、肌酐(P<0.001)、APACHEⅡ评分(P<0.001)等方面存在统计学差异。多因素Logistic回归分析显示,敌百虫血药浓度≥0.44μg/mL、APACHEⅡ评分≥10.5分是AOPP并发CLS的独立危险因素。CLS组患者的死亡率明显高于非CLS组(P<0.001)。结论AOPP患者较易并发CLS,且死亡率较高,临床上可通过敌百虫血药浓度、APACHEⅡ评分早期识别高风险患者,及早进行干预,以改善患者预后。Objective To explore the risk factors of capillary leakage syndrome in patients with acute organophosphorus pesticide poisoning(AOPP),in order to provide reference for clinical screening and inter-vention timing.Methods The clinical manifestations,auxiliary examination and prognosis of AOPP patients admitted in Fuyang People's Hospital from November 2020 to June 2022 were prospectively analyzed,and the patients were divided into non-CLS group and CLS group based on the presence or absence of capillary leak syn-drome(CLS).Patients were admitted to hospital as the starting point,and death or discharge as the end point.Multiple Logistic regression analysis was used to explore the risk factors of AOPP complicated with CLS.Results A total of 38 AOPP patients were included,of which 17(44.7%)were complicated with CLS.There were statistical differences in age(P=0.015),blood concentration of dichlorvos(P=0.001),blood concentration of dipterex(P<0.001),creatinine(P<0.001)and APACHEⅡscore(P<0.001)between non-CLS group and CLS group.Multivariate Logistic regression analysis showed that blood concentration of dip-terex≥0.44μg/mL and APACHEⅡscore≥10.5 were independent risk factors for AOPP complicated with CLS.The mortality rate of CLS group was higher than that of CLS group(P<0.001).Conclusions Patients with AOPP are more likely to be complicated by CLS,and the mortality rate is higher.High-risk patients can be identified early by dipterex blood concentration and APACHEⅡscore,and early intervention can be carried out to improve the prognosis of patients.

关 键 词：急性有机磷农药中毒 毛细血管渗漏综合征 敌百虫 

分 类 号：R825.92[医药卫生—临床医学] R459.7