有机磷中毒后代谢指标动态变化情况及其与住院期间预后的相关性  

Dynamic changes in metabolic indexes following organophosphorus poisoning and their correlation with prognosis in hospital

作　　者：徐勋宏 徐茂华 李晓红 XU Xunhong;XU Maohua;LI Xiaohong(Department of Emergency,Chun'an Branch of Zhejiang Provincial People's Hospital,Hangzhou,Zhejiang 311700,China;不详)

机构地区：[1]浙江省人民医院淳安分院急诊科,浙江杭州311700 [2]浙江省人民医院重症医学科

出　　处：《中华全科医学》2025年第1期94-97,126,共5页Chinese Journal of General Practice

基　　金：浙江省医药卫生科技计划项目(2023XY144)。

摘　　要：目的有机磷中毒具有发病急、变化快等特点,若处理不及时可出现昏迷,甚至死亡。代谢指标在急性有机磷中毒后处于动态变化中,并具有预测有机磷中毒预后的潜能。为此本研究通过测量有机磷中毒患者代谢指标动态变化情况,探讨有机磷中毒患者代谢指标动态变化情况及其与预后的相关性。方法纳入2021年1月—2022年12月浙江省人民医院淳安分院急诊医学科治疗的245例有机磷中毒患者为研究对象,采集所有患者中毒后72 h内血样,分析患者代谢指标动态变化。同时收集有机磷中毒患者预后情况,采用Cox回归方程分析有机磷中毒患者代谢指标动态变化与预后的相关性。结果中毒后72 h内患者随机血糖、钠离子、血肌酐、血尿素氮均处于动态变化中,但氯离子水平变化不明显。245例患者中共56例患者死亡纳入预后不良组,189例患者好转纳入好转组;Cox回归分析显示,高钠离子变化值(HR=2.958,P=0.021)、血肌酐变化值(HR=4.759,P<0.001)、血尿素氮变化值(HR=7.101,P<0.001)及年龄大(HR=1.109,P=0.001)、中毒至入院时间长(HR=6.872,P<0.001)是有机磷中毒患者死亡的危险因素,乙酰胆碱酯酶(AChE)活性高(HR=0.910)是有机磷中毒患者死亡的保护因素(P<0.05)。结论中毒后72 h内患者随机血糖、钠离子、血肌酐、血尿素氮均处于动态变化中,但氯离子水平变化不明显,且钠离子、血肌酐、血尿素氮动态变化情况及年龄、中毒至入院时间、AChE活性与有机磷中毒患者预后显著相关。Objective Organophosphorus poisoning has an acute onset and progresses rapidly.Without timely treatment,it may lead to coma or even death.Metabolic indexes change dynamically following acute organophosphorus poisoning,which have the potential value to predict the prognosis of organophosphorus poisoning.Therefore,this study explores the correlation between the dynamic changes of metabolic indexes and prognosis of patients.Methods From January 2021 to December 2022,245 patients with organophosphorus poisoning at the Emergency Medicine Department of the Chun'an Branch of Zhejiang Provincial People's Hospital were selected as the research object.The blood samples were collected within 72 hours post-poisoning,and the dynamic changes of metabolic indexes were analyzed.At the same time,the prognosis of patients with organophosphorus poisoning were collected,and the correlation between the dynamic changes in metabolic indexes and prognosis was analyzed by Cox regression analysis.Results The random blood sugar,sodium ion,serum creatinine,and blood urea nitrogen all changed dynamically within 72 hours after poisoning,while the chloride ion level showed no significant variation.Among the 245 patients,56(poor prognosis group)died,while 189(improved prognosis group)recovered.The sodium ion(HR=2.958,P=0.021),serum creatinine(HR=4.759,P<0.001),blood urea nitrogen(HR=7.101,P<0.001),old age(HR=1.109,P=0.001),and longer time from poisoning to admission(HR=6.872,P<0.001)were the risk factors for the death of patients with organophosphate poisoning.High AChE activity was identified as a protective factor for the death of patients with organophosphorus poisoning(HR=0.910,P<0.05).Conclusion The patients'random blood sugar,sodium ion,serum creatinine,and blood urea nitrogen exhibit dynamic changes within 72 hours after poisoning,while chloride ion levels remain stable.Dynamic changes in sodium ion,serum creatinine,and blood urea nitrogen,as well as age,time to admission,and AChE activity,are significantly related to the prognosis of pa

关 键 词：有机磷中毒 代谢 动态变化 预后 

分 类 号：R595.4[医药卫生—内科学]