急性有机磷农药中毒患者并发毛细血管渗漏综合征的危险因素分析

Risk Factors of Capillary Leak Syndrome in Patients with Acute Organophosphorus Pesticide Poisoning

  • 摘要:
    目的 探索急性有机磷农药中毒(acute organophosphorus pesticide poisoning, AOPP)患者并发毛细血管渗漏综合征(capillary leak syndrome, CLS)的危险因素, 为早期预防及诊断AOPP并发CLS提供参考。
    方法 前瞻性收集2020年11月—2022年6月阜阳市人民医院急诊科连续收治的AOPP患者临床资料, 包括临床表现、辅助检查及预后情况等, 根据是否并发CLS将其分为CLS组和非CLS组。以患者入院为观察起点, 以死亡或出院为观察终点, 采用多因素Logistic回归分析探索AOPP并发CLS的危险因素。
    结果 共纳入38例AOPP患者, 其中17例(44.7%)并发CLS; 非CLS组与CLS组患者在年龄(P=0.015)、敌敌畏血药浓度(P=0.001)、敌百虫血药浓度(P<0.001)、肌酐(P<0.001)、APACHE Ⅱ评分(P<0.001)等方面存在统计学差异。多因素Logistic回归分析显示, 敌百虫血药浓度≥0.44 μg/mL、APACHE Ⅱ评分≥10.5分是AOPP并发CLS的独立危险因素。CLS组患者的死亡率明显高于非CLS组(P<0.001)。
    结论 AOPP患者较易并发CLS, 且死亡率较高, 临床上可通过敌百虫血药浓度、APACHEⅡ评分早期识别高风险患者, 及早进行干预, 以改善患者预后。

     

    Abstract:
    Objective To explore the risk factors of capillary leakage syndrome in patients with acute organophosphorus pesticide poisoning (AOPP), in order to provide reference for clinical screening and intervention timing.
    Methods The clinical manifestations, auxiliary examination and prognosis of AOPP patients admitted in Fuyang People's Hospital from November 2020 to June 2022 were prospectively analyzed, and the patients were divided into non-CLS group and CLS group based on the presence or absence of capillary leak syndrome (CLS). Patients were admitted to hospital as the starting point, and death or discharge as the endpoint. Multiple Logistic regression analysis was used to explore the risk factors of AOPP complicated with CLS.
    Results A total of 38 AOPP patients were included, of which 17 (44.7%) were complicated with CLS. There were statistical differences in age (P=0.015), blood concentration of dichlorvos (P=0.001), blood concentration of dipterex(P < 0.001), creatinine (P < 0.001) and APACHEⅡ score (P < 0.001) between non-CLS group and CLS group. Multivariate Logistic regression analysis showed that blood concentration of dipterex ≥0.44 μg/mL and APACHEⅡ score≥10.5 were independent risk factors for AOPP complicated with CLS. The mortality rate of CLS group was higher than that of CLS group (P < 0.001).
    Conclusions Patients with AOPP are more likely to be complicated by CLS, and the mortality rate is higher. High-risk patients can be identified early by dipterex blood concentration and APACHE Ⅱ score, and early intervention can be carried out to improve the prognosis of patients.

     

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