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目的探讨急性有机磷农药中毒死亡的危险因素。方法回顾性分析2004年9月至2005年8月87例急性有机磷农药中毒患者的临床资料,按照是否合并低血压、低氧血症、代谢性酸中毒以及APACHEⅡ分值分别对入选患者进行分组,对各项危险因素进行x~2检验,比较组间患者的病死率。结果87例急性有机磷农药中毒患者住院期间病死率21.8%。68例存活者APACHEⅡ评分(7.58±5.32)分与19例死亡患者(21.17±9.46)分相比,差异具有统计学意义(r=9.25,P<0.05)。APACHEⅡ分值≥20分患者的病死率[6562%(15/23例)]与分值<20分患者患者的病死率[6.3%(4/64)]相比差异有统计学意义(RR=10.4,95% CI=4.8～22.8,x~2=34.5,P<0.01)。合并低血压的患者病死率[34.3%(12/35)]与未合并低血压的患者[13.5%(7/52)]相比差异有统计学意义(RR=2.55,95% CI=1.2～5.6,x~2=5.31,P<0.05)。合并低氧血症的患者病死率[37.5%(9/24)]与未合并低氧血症的患者[15.9%(10/63)相比差异有统计学意义(RR= 2.36,95% CI=1.1～5.1,x~2=4.76,P<0.05)。合并代谢性酸中毒的患者病死率[31.7%(13/ 41)]与未合并代谢性酸中毒的患者[13.0%(6/46例)]相比差异有统计学意义(RR=2.43,95% CI=1.1～5.6,x~2=4.42,P<0.05),且患者的病死率随着血pH值的降低而上升(Pearson=0.37,x~2=6.65,P<0.05)。结论低血压、低氧血症、代谢性酸中毒、APACHEⅡ分值可能是急性有机磷农药中毒患者死亡的危险因素。
Objective To investigate the risk factors of acute organophosphorus pesticide poisoning death. Methods The clinical data of 87 patients with acute organophosphorus pesticide poisoning from September 2004 to August 2005 were retrospectively analyzed. The patients were divided into groups according to whether they were complicated by hypotension, hypoxemia, metabolic acidosis and APACHE Ⅱ scores , The risk factors for x ~ 2 test, compare the mortality of patients in the group. Results 87 cases of acute organophosphorus pesticide poisoning hospitalization during the fatality rate of 21.8%. The APACHEⅡscore of 68 survivors (7.58 ± 5.32) was significantly lower than that of 19 patients (21.17 ± 9.46) (r = 9.25, P <0.05). Patients with an APACHE II score ≥20 had a significantly higher case fatality rate (6562% (15/23)) compared with those with a score of <20 (6.3% (4/64)] (RR = 10.4, 95% CI = 4.8 ~ 22.8, x ~ 2 = 34.5, P <0.01). The mortality rate in patients with hypotension was 34.3% (12/35), compared with 13.5% (7/52) in patients without hypotension (RR = 2.55, 95% CI = 5.6, x ~ 2 = 5.31, P <0.05). Mortality in patients with hypoxemia (37.5% (9/24)] was statistically different from those in patients without hypoxemia (15.9%, 10/63) (RR = 2.36, 95% CI = 1.1 ~ 5.1, x ~ 2 = 4.76, P <0.05). Patients with metabolic acidosis had a statistically significant difference in mortality (31.7% (13/41) vs 13.0% (6/46 cases) without metabolic acidosis (RR = 2.43, 95 % CI = 1.1 ~ 5.6, x ~ 2 = 4.42, P <0.05). The mortality of patients increased with the decrease of blood pH value (Pearson = 0.37, x ~ 2 = 6.65, P <0.05). Conclusion Hypotension, hypoxemia, metabolic acidosis and APACHE Ⅱ score may be the risk factors of death in patients with acute organophosphorus pesticide poisoning.