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急性肾功能衰竭(ARF)是有机磷农药中毒(OPI)患者的严重并发症和常见致死原因之一,我们两个医院于1976年1月～1987年3月共收治OPI合并ARF10例,占同期OPI患者的21.8％。所有病例经检查证实发病前有内服有机磷农药史。本组ARF的诊断标准 (1) 在OPI发生前无明显肾脏病史;(2) 以OPI为契机出现休克,少尿或无尿等临床表现;(3) 病程中出现肉眼血尿和/或血红蛋白尿,尿液检查见有蛋白,细胞及管型;(4) 血液生化检查尿素氮(BuN)≥50mg/dl,或肌肝(Cr)≥3mg/dl,和/或伴有代谢性酸中毒,高钾血症、低钙血症等电解质异常。符合上述四顶或其中三顶(1,2.4或1,3,4)诊断标准者,则诊断为ARF。本文对OPI合并ARF患者进行分析,探讨发病机理,诊断和治疗。
Acute renal failure (ARF) is a serious complication and one of the common causes of death in patients with organophosphate pesticide poisoning (OPI). The two hospitals treated 10 cases of OPI combined with ARF from January 1976 to March 1987, 21.8% of patients with OPI. All cases confirmed by the test before onset of oral organophosphate pesticide history. The diagnostic criteria of this group of ARF (1) before the onset of OPI no significant history of renal disease; (2) the OPI as an opportunity to shock, oliguria or anuria and other clinical manifestations; (3) during the course of gross hematuria and / or hemoglobinuria (4) blood biochemical tests of urea nitrogen (BuN) ≥ 50mg / dl, or muscle liver (Cr) ≥ 3mg / dl, and / or accompanied by metabolic acidosis, Hyperkalemia, hypocalcemia and other electrolyte abnormalities. Those who meet the above four or three (1,2,4 or 1,3,4) diagnostic criteria, then diagnosed as ARF. In this paper, OPI patients with ARF were analyzed to explore the pathogenesis, diagnosis and treatment.