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目的探讨急性有机磷农药中毒并发上消化道出血患者的临床情况。方法 186例急性有机磷农药中毒患者作为研究对象,根据患者的临床症状进行分组:93例出现上消化道出血的患者作为观察组,93例未出现上消化道出血的患者作为对照组,记录观察组患者上消化道出血发生情况,比较两组患者血糖浓度、急性生理学及慢性健康状况评分Ⅱ(APACHEⅡ)、血清胆碱酯酶水平。结果观察组患者消化道出血108次,其中毒物损伤胃黏膜71次,洗胃损伤20次,应激性溃疡17次。出现上消化道出血的时间为0.50~90.00 h,平均时间(11.87±29.68)h。两组患者的血糖浓度比较,差异无统计学意义(P>0.05);观察组患者入院24 h APACHEⅡ评分为(16.52±6.20)分高于对照组的(10.03±5.91)分,差异有统计学意义(P<0.05);观察组患者血清胆碱酯酶水平为(323.62±109.13)U/L低于对照组的(420.32±122.75)U/L,差异有统计学意义(P<0.05)。结论通过APACHEⅡ评分以及血清胆碱酯酶可以有效判断急性有机磷农药中毒患者上消化道出血的具体情况,值得在临床推广应用。
Objective To investigate the clinical situation of acute organophosphorus pesticide poisoning in patients with upper gastrointestinal bleeding. Methods A total of 186 patients with acute organophosphorus pesticide poisoning were enrolled and divided into groups according to the clinical symptoms of the patients: 93 patients with upper gastrointestinal bleeding as observation group and 93 patients without upper gastrointestinal bleeding as control group. The incidence of upper gastrointestinal bleeding was compared between the two groups. The blood glucose levels, acute physiology and chronic health status Ⅱ (APACHEⅡ) and serum cholinesterase levels were compared between the two groups. Results In the observation group, there were 108 cases of gastrointestinal bleeding, in which the toxicant injured gastric mucosa 71 times, gastric lavage 20 times and stress ulcer 17 times. The upper gastrointestinal bleeding time was 0.50 ~ 90.00 h, the average time (11.87 ± 29.68) h. There was no significant difference in blood glucose concentration between the two groups (P> 0.05). The APACHEⅡscore of the observation group was (16.52 ± 6.20) higher than that of the control group at 24 h (10.03 ± 5.91), the difference was statistically significant (P <0.05). The serum cholinesterase level in the observation group was (323.62 ± 109.13) U / L less than that in the control group (420.32 ± 122.75) U / L, the difference was statistically significant (P <0.05). Conclusion APACHE Ⅱ score and serum cholinesterase can effectively determine the specific circumstances of acute organophosphorus pesticide poisoning in patients with upper gastrointestinal bleeding, it is worth in the clinical application.