论文部分内容阅读
目的:了解大型综合性教学医院抢救室急性中毒的流行病学特点及治疗现状,以期对急性中毒的诊治和研究提供参考。方法:本研究回顾性分析2011-08-2015-07我院急诊抢救室登记的急性中毒患者的临床资料,包括性别、年龄、毒物种类、中毒方式、中毒原因、就诊时间、洗胃时间、血液净化时间等。结果:共纳入479例急性中毒患者,197例(41.13%)为男性,平均年龄(41.59±19.10)岁,女性282例(58.87%),平均年龄(40.04±17.42)岁,男女之比1∶1.43。无论男女,各年龄段的人数分布趋势基本一致,中毒人数均在20~29岁达高峰,30~39岁次之。毒物种类共66种,4年间仅出现1次的毒物32种。各类中毒以农药中毒272例(56.79%)位居第1,其次是药物中毒118例(24.63%)。单一毒物中毒439例(91.65%),混合毒物中毒33例(6.89%)。排名前3位的依次为百草枯157例(32.78%)、有机磷78例(16.28%)、镇静催眠药59例(11.69%)。急性中毒的方式以消化道摄入为主,437例(91.23%)。自杀是中毒的主要原因,416例(86.85%)。急性中毒以秋季发病最多,冬季发病最少。入院后予以洗胃366例(83.75%),其中发病1h以内实施洗胃156例(42.62%),1~6h洗胃174例(47.54%),>6h洗胃的36例(9.84%)。实施血液净化135例(27.61%),其中86.67%为农药中毒,75例(55.56%)于发病6h后实施血液净化。同时行洗胃及血液净化的128例(26.72%),该组患者发病至洗胃时间为(3.41±6.16)h,发病至血液净化的平均时间长达(8.28±7.23)h,血液净化比洗胃平均延迟(4.92±4.01)h。患者转归:144例(30.06%)患者在抢救室治疗无望后自动出院。294例(61.38%)患者在抢救室初步处理后转入急诊的各个区继续治疗,仅有3例患者收住其他专科继续治疗。结论:本研究为单中心回顾性研究,不具有广泛的代表性。但本研究的急性中毒流行病学资料及洗胃和血液净化的临床资料对本地区急性中毒防治及优化提供了一定的参考依据。
Objective: To understand the epidemiological characteristics and treatment of acute poisoning in emergency room in large comprehensive teaching hospital so as to provide reference for the diagnosis and treatment of acute poisoning. Methods: This study retrospectively analyzed the clinical data of acute poisoning patients registered in emergency room of our hospital from 2011-08-2015-07, including gender, age, poison types, poisoning methods, causes of poisoning, visit time, gastric lavage time, blood Purification time. Results: A total of 479 acute poisoning patients were enrolled, 197 (41.13%) were male, mean age (41.59 ± 19.10) years, 282 women (58.87%), average age 40.04 ± 17.42, 1.43. Both men and women, the distribution trend of the number of people of all ages are basically the same, the number of poisoning peaked in 20 to 29 years old, followed by 30 to 39 years. A total of 66 kinds of poison species, only 4 times a poison 32 species. All kinds of poisoning took the first place in 272 cases (56.79%) with pesticide poisoning, followed by drug poisoning in 118 cases (24.63%). Single poison poisoning 439 cases (91.65%), mixed poison poisoning in 33 cases (6.89%). The top three ranked 157 paraquat (32.78%), 78 organic phosphorus (16.28%), and sedative and hypnotics 59 (11.69%). Acute poisoning is mainly based on gastrointestinal ingestion, 437 cases (91.23%). Suicide is the main reason of poisoning, 416 cases (86.85%). Acute poisoning in the most incidence in autumn, winter onset at least. There were 366 gastric lavage cases (83.75%) admitted to hospital, of which 156 cases (42.62%) were gastric lavage within 1 hour, 174 cases (47.54%) were lavaged after 1 ~ 6 hours and 36 cases (9.84%) were gastric lavage after 6 hours. Blood purification was performed in 135 cases (27.61%), of which 86.67% were pesticide poisonings and 75 cases (55.56%) performed blood purification 6 hours after the onset of disease. There were 128 patients (26.72%) with gastric lavage and blood purification at the same time. The time from onset to gastric lavage was (3.41 ± 6.16) h and the average time from onset to blood purification was (8.28 ± 7.23) h. The blood purification ratio Gastric lavage average delay (4.92 ± 4.01) h. Patient Outcomes: 144 patients (30.06%) were discharged spontaneously after hopeless treatment in the emergency room. A total of 294 patients (61.38%) were treated in the emergency department after initial treatment and only 3 patients received other specialties for further treatment. Conclusion: This study is a one-center retrospective study that does not have broad representation. However, the epidemiological data of acute poisoning and clinical data of gastric lavage and blood purification in this study provide some references for the prevention and control of acute poisoning in this area.