急性有机磷农药中毒导致的继发性系统性毛细血管渗漏综合征的临床特征分析  

Clinical characteristics analysis of secondary systemic capillary leak syndrome induced by acute organophosphorus pesticide poisoning

作　　者：杨一红 马腾飞[1] 刘旗旗 刘洪波 王显[2] 刘业成[3] Yang Yihong;Ma Tengfei;Liu Qiqi;Liu Hongbo;Wang Xian;Liu Yecheng(Department of Emergency Medicine,Fuyang People’s Hospital Affi liated to Anhui Medical University,Fuyang 236004,China;Department of Nephrology,Fuyang People’s Hospital Affi liated to Anhui Medical University,Fuyang 236004,China;Department of Emergency Medicine,Peking Union Medical College Hospital,Beijing 100730,China)

机构地区：[1]安徽医科大学附属阜阳人民医院急诊科,阜阳236004 [2]安徽医科大学附属阜阳人民医院肾内科,阜阳,236004 [3]北京协和医院急诊科,北京100730

出　　处：《中华急诊医学杂志》2025年第4期582-587,共6页Chinese Journal of Emergency Medicine

基　　金：安徽省阜阳市科技局重点研究与开发计划项目(FYZDYF2023LCYX034);国家卫健委“创新药物上市后临床研究科研专项”面上课题(WKZX2023CX170008)。

摘　　要：目的探讨急性有机磷农药中毒导致的继发性系统性毛细血管渗漏综合征(secondary systemic capillary leak syndrome,SSCLS)的临床特征和危险因素,旨在提高临床对该并发症的认识,为早期识别高危患者、优化个体化诊疗方案提供理论依据。方法收集2019年10月至2024年10月安徽医科大学附属阜阳人民医院急诊科收治的主诉为敌敌畏的急性有机磷中毒患者的临床资料,描述其并发SSCLS的临床特征,并将患者分为SSCLS组和非SSCLS组,对两组差异有统计学意义的指标进行二元多因素Logistic回归分析,筛选影响该类中毒导致SSCLS的独立危险因素,并绘制预测SSCLS受试者工作特征(receiver operating characteristi,ROC)曲线。结果96例患者37例(38.5%)发生SSCLS,从摄入毒物到发生SSCLS的中位数时间为3.0(2.0,5.0)h。14例SSCLS存活的患者其SSCLS持续的中位数时间为50.0(24,72)h。23例SSCLS死亡的患者其SSCLS持续的时间中位数为24.0(12.0,35.0)h。SSCLS组患者的病死率为62.2%(23/37),远远高于非SSCLS组患者1.7%(1/59),差异有统计学意义(χ^(2)=44.343,P﹤0.001)。92例(95.8%)患者血液毒物检测含有复合敌百虫成分。二元多因素Logistic回归分析,APACHEII评分和敌百虫浓度(≥706.35 ng/mL)是患者发生SSCLS的独立危险因素(P<0.05)。ROC曲线显示:两个独立危险因素对预测SSCLS的发生均有一定的价值,两指标联合预测价值更大(P<0.05)。结论在急性有机磷农药敌敌畏中毒的诊治中,应特别关注敌敌畏合并敌百虫导致SSCLS的联合毒性作用。SSCLS发作和病情进展较快,且病死率较高。APACHEⅡ评分和敌百虫浓度(≥706.35 ng/mL)是SSCLS发生的独立危险因素,两指标联合预测价值更大。早期识别高危患者并及时给予个体化治疗,对于降低患者的病死率极其重要。Objective To investigate the clinical characteristics and risk factors associated with secondary systemic capillary leak syndrome(SSCLS)induced by acute organophosphorus pesticide poisoning(AOPP).The goal is to enhance clinical understanding of this complication and provide a theoretical foundation for the early identifi cation of high-risk patients and the optimization of individualized treatment strategies.Methods Clinical data were collected from patients admitted to the Emergency Department of Fuyang People’s Hospital Affi liated to Anhui Medical University between October 2019 and October 2024,who were diagnosed with acute dichlorvos poisoning.The clinical features of SSCLS were described,and patients were categorized into SSCLS and non-SSCLS groups.Binary multivariate logistic regression analysis was conducted on statistically significant indicators to identify independent risk factors for SSCLS.Receiver operating characteristic(ROC)curves were generated to evaluate the predictive value of these factors.Results Among the 96 patients studied,37(38.5%)developed SSCLS.The median time from toxin ingestion to the onset of SSCLS was 3.0(2.0-5.0)hours.In the 14 SSCLS survivors,the median duration of SSCLS was 50.0(24-72)hours,whereas in the 23 non-survivors,it was 24.0(12.0-35.0)hours.The mortality rate in the SSCLS group(62.16%,23/37)was signifi cantly higher than that in the non-SSCLS group(1.69%,1/59)(χ^(2)=44.343,P<0.001).Blood toxin analysis detected trichlorfon components in 92 patients(95.83%).Binary multivariate logistic regression identifi ed APACHEⅡscore and trichlorfon concentration(≥706.35 ng/mL)as independent risk factors for SSCLS(P<0.05).ROC analysis revealed that the combination of these two factors had a higher predictive value(P<0.05).Conclusions In the diagnosis and treatment of acute dichlorvos(organophosphorus pesticide)poisoning,particular attention should be given to the combined toxic effects of dichlorvos and trichlorfon,which can lead to SSCLS.The onset and progression of SSCLS are

关 键 词：有机磷 敌敌畏 敌百虫 中毒 毛细血管渗漏综合征 临床特征 

分 类 号：R595.4[医药卫生—内科学]