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目的回顾该院ICU建科以来重症中毒病例的流行病学特点,为未来中毒患者的管理提供更好的依据。方法回顾性分析1998年9月—2016年9月该院ICU收治的所有重症中毒患者流行病学特点和救治情况。记录APACHEⅡ评分、毒物接触时间、平均住院时间、呼吸机使用率、血液净化使用率等。结果共纳入35例患者,占ICU总住院病例的1.7%。其中男∶女为1∶2.2;年龄18~86岁,中位数为36岁,年龄分布以20~39岁组最为多见,19例(54.3%)。平均APACHEⅡ评分为(20.2±8.9)分,中位毒物接触时间5(3~12)h,中位住院时间为3(2~5)d。自杀服毒为首要原因,20例(57.1%);其次为意外中毒8例(22.9%);误服4例(11.4%)。31例(88.6%)患者为经口摄入毒物。11例(31.4%)院前接受过心肺复苏术,19例(54.3%)患者合并多脏器功能不全(MODS),18例(51.4%)患者接受机械通气治疗,22例(62.9%)患者接受了血液净化治疗,总的病死率为10/35(28.5%)。与存活组相比,死亡组中APACHEⅡ评分显著增高(P<0.01),而接触毒物时间、平均住院时间、接受血液净化治疗比率差异无统计学意义(P>0.05)。死亡组合并MODS发生率;接受院外心肺复苏、机械通气比率更高(P<0.01)。结论这些数据对于我院ICU今后收治重症中毒患者有指导意义。
Objective To review the epidemiological characteristics of severe poisoning cases since the ICU was established in the hospital and provide a better basis for the management of future poisoning patients. Methods The epidemiological characteristics and treatment of all critically ill patients admitted to ICU from September 1998 to September 2016 were retrospectively analyzed. Record APACHE Ⅱ score, poison contact time, average length of stay, ventilator usage, blood purification usage and so on. Results A total of 35 patients were enrolled, accounting for 1.7% of the total inpatient ICU cases. Among them, the male and the female were 1: 2.2; the age ranged from 18 to 86 years. The median was 36 years old. The age distribution was the most common in 20-39 years old group, 19 cases (54.3%). The average APACHE II score was (20.2 ± 8.9) points, median poison contact time was 5 (3 ~ 12) h, and the median length of stay was 3 (2 ~ 5) days. Serious suicide was the main reason, 20 cases (57.1%); followed by accidental poisoning in 8 cases (22.9%); 4 cases (11.4%). Twenty-one patients (88.6%) were orally ingested. Eleven patients (31.4%) underwent cardiopulmonary resuscitation, 19 (54.3%) had multiple organ dysfunction (MODS), 18 patients (51.4%) received mechanical ventilation and 22 (62.9% Undergoing blood purification treatment, the overall case fatality rate was 10/35 (28.5%). The APACHEⅡ score in the death group was significantly higher than that in the survivor group (P <0.01). There was no significant difference in the exposure time, the average length of hospital stay, and the rate of blood purification in the death group (P> 0.05). Mortality combined with MODS incidence; receiving out-of-hospital cardiopulmonary resuscitation, a higher rate of mechanical ventilation (P <0.01). Conclusion These data are of guiding significance for the future treatment of patients with severe poisoning in ICU of our hospital.