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目的:探讨胃内灌注对急性重度有机磷中毒(ASOP)患者的治疗效果,分析影响ASOP患者预后的独立影响因素。方法:收集2020年6月—2021年12月就诊于宜昌市中心人民医院重症医学科行洗胃+胃肠导泻的ASOP患者为对照组(n=47),2022年1月—2023年6月就诊的行洗胃+胃肠导泻+胃内灌注的ASOP患者为观察组(n=39)。回顾性收集所有患者的临床资料,对比分析两组患者的临床疗效。进行单因素及多因素Cox回归分析ASOP患者预后的独立影响因素,采用R软件绘制Nomogram风险预测模型并进行模型校正。结果:观察组患者的肠道清洗时间、胆碱酯酶(Ch E)恢复时间、阿托品化时间、阿托品使用剂量、机械通气时间、住院时间和中间综合征较对照组均明显减少(均P<0.05)。多因素Cox回归分析显示,两组患者服药剂量、服药到洗胃时间、C反应蛋白(CRP)、Ch E、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)是ASOP患者预后的独立影响因素。Nomogram结果(C-index=0.949)显示,该模型区分度较好。结论:洗胃+胃肠导泻+胃内灌注能有效提高ASOP患者的治疗效果,服药剂量、服药到洗胃时间、CRP、Ch E及APACHEⅡ是患者预后的独立影响因素。
Abstract：Objective: To investigate the therapeutic effect of gastric perfusion on patients with acute severe organophosphorus poisoning(ASOP), and analyze the independent factors affecting the prognosis of ASOP patients. Methods: ASOP patients admitted to Intensive Care Department of Yichang Central People's Hospital from June 2020 to December 2021 who underwent gastric lavage + gastrointestinal diarrhea were selected as the control group(n=47), and ASOP patients admitted from January 2022 to June 2023 who underwent gastric lavage + gastrointestinal diarrhea + gastric perfusion were selected as the observation group(n=39). The clinical data of all patients were collected retrospectively, and the clinical effects of the two groups were compared and analyzed. Univariate and multifactor Cox regression analysis were conducted to analyze the independent prognostic factors of ASOP patients. R software was used to construct a Nomogram risk prediction model and then the model was calibrated. Results: The intestinal cleaning time, cholinesterase(Ch E) recovery time, atropinization time, atropine dose, mechanical ventilation time, hospital stay and intermediate syndrome in observation group were significantly reduced compared with control group(all P<0.05). Multivariate Cox regression analysis showed that dosage, time from administration to gastric lavage, C-reactive protein(CRP), Ch E, acute physiology and chronic health evaluation scoring system Ⅱ(APACHEⅡ) were independent factors affecting the prognosis of patients with ASOP. Nomogram result(C-index=0.949) showed that gastric perfusion + gastrointestinal diarrhea had a certain effect on the prognosis of patients. Conclusion: Gastric lavage + gastrointestinal catharsis + gastric perfusion can effectively improve the therapeutic effect of ASOP patients. Dosage, time from administration to gastric lavage, CRP, Ch E andAPACHE Ⅱ are independent factors affecting the prognosis of patients.
[1] Eddleston M, Nagami H, Lin C Y, et al. Pesticide use,agricultural outputs, and pesticide poisoning deaths in Japan[J]. Clin Toxicol, 2022, 60(8):933-941.
[2] Jacob J, Reddy C K, James J. The toxic depot:parenteral insecticide injection[J]. Indian J Crit Care Med,2022, 26(7):877-878.
[3] Ghimire R, Utyasheva L, Pokhrel M, et al. Intentional pesticide poisoning and pesticide suicides in Nepal[J].Clin Toxicol, 2022, 60(1):46-52.
[4] Chowdhury F R, Dewan G, Verma V R, et al. Bans of WHO Class I Pesticides in Bangladesh-suicide prevention without hampering agricultural output[J]. Int J Epidemiol, 2018, 47(1):175-184.
[5] Caba I C, StreangǎV, Dobrin M E, et al. Clinical assessment of acute organophosphorus pesticide poisoning in pediatric patients admitted to the toxicology emergency department[J]. Toxics, 2022, 10(10):582.
[6] Pannu A K, Bhalla A, Vishnu R I, et al. Organophosphate induced delayed neuropathy after an acute cholinergic crisis in self-poisoning[J]. Clin Toxicol, 2021, 59(6):488-492.
[7] Methods Medicine C A M. Retracted:expression of hypersensitive troponin I and soluble ST2 in acute organophosphorus pesticide poisoning[J]. Comput Math Methods Med, 2023, 2023:9781450.
[8] Hosseini S M, Rahimi M, Afrash M R, et al. Prediction of acute organophosphate poisoning severity using machine learning techniques[J]. Toxicology, 2023,486:153431.
[9] Elsinghorst P W, Worek F, Thiermann H, et al. Drug development for the management of organophosphorus poisoning[J]. Expert Opin Drug Discov, 2013, 8(12):1467-1477.
[10]Wu J H, Ma X H, Dong J H, et al. Evaluation and use of organs from donors poisoned by organophosphorus pesticide[J]. Ann Transplant, 2023, 28:e939343.
[11]Liu X T, Wang L, Chen J, et al. Expression of hypersensitive troponin I and soluble ST2 in acute organophosphorus pesticide poisoning[J]. Comput Math Methods Med, 2022, 2022:1427231.
[12]中国医师协会急诊医师分会.急性有机磷农药中毒诊治临床专家共识(2016)[J].中国急救医学, 2016, 36(12):1057-1065.
[13]Lyagin I, Efremenko E. Enzymes, reacting with organophosphorus compounds as detoxifiers:diversity and functions[J]. Int J Mol Sci, 2021, 22(4):1761.
[14]Li W, Rong Y C, Wang J Y, et al. Mn O2 switchbridged DNA walker for ultrasensitive sensing of cholinesterase activity and organophosphorus pesticides[J].Biosens Bioelectron, 2020, 169:112605.
[15]Pundir C S, Malik A, Preety. Bio-sensing of organophosphorus pesticides:a review[J]. Biosens Bioelectron, 2019, 140:111348.
[16]Hulse E J, Clutton R E, Drummond G, et al. Lung injury caused by aspiration of organophosphorus insecticide and gastric contents in pigs[J]. Clin Toxicol,2022, 60(6):725-736.
[17]Hulse E J, Smith S H, Wallace W A, et al. Development of a histopathology scoring system for the pulmonary complications of organophosphorus insecticide poisoning in a pig model[J]. PLo S One, 2020, 15(10):e0240563.
[18]Eddleston M, Mohamed F, Davies J O J, et al. Respiratory failure in acute organophosphorus pesticide selfpoisoning[J]. QJM, 2006, 99(8):513-522.
[19]Hulse E J, Davies J O J, Simpson A J, et al. Respiratory complications of organophosphorus nerve agent and insecticide poisoning. Implications for respiratory and critical care[J]. Am J Respir Crit Care Med, 2014, 190(12):1342-1354.
[20]Malaviya N B, Parikh R, Pancholi K, et al. Assessment of the peradeniya organophosphorus poisoning scale as a severity and prognostic marker in patients with acute organophosphorus poisoning presenting to an emergency medicine department[J]. Cureus, 2023, 15(6):e40277.
[21]秦勇,简华刚,黄圣杰,等.早期强化导泻治疗急性有机磷农药中毒的疗效研究[J].重庆医学, 2021, 50(11):1866-1869.
[22]贺晶,吴淑芹.胃内灌注和导泻交替进行救治有机磷中毒患者的效果观察[J].国际医药卫生导报, 2017, 23(6):890-892.
[23]田飞,张蓉,郭庆,等.急性百草枯中毒预后影响因素的研究[J].巴楚医学, 2020, 3(1):19-25.
[24]林永强.阿托品、氯解磷定与生大黄粉联合治疗有机磷农药中毒的临床效果[J].临床合理用药杂志, 2021, 14(29):101-103.
[25]高勤虎,邹洁,管红宝,等.大黄解毒汤联合血液净化对重症急性有机磷中毒患者心肾功能及hs-CRP、IL-1β、TNF-α水平的影响[J].广州中医药大学学报,2023, 40(8):1922-1927.
[26]曾美.重度有机磷中毒患者留置胃管行思密达与活性炭洗胃疗效观察[J].护理学报, 2013, 20(6):40-41.
[27]张曦予.混合直投式益生菌发酵剂、活性乳制品研发及其贮藏性能研究[D].南宁:广西大学, 2022.
[28]Bhatt P, Solra M, Chaudhury S I, et al. Metal coordination-driven supramolecular nanozyme as an effective colorimetric biosensor for neurotransmitters and organophosphorus pesticides[J]. Biosensors, 2023, 13(2):277.
[29]Gómez-Canela C, Tornero-Ca?adas D, Prats E, et al.Comprehensive characterization of neurochemicals in three zebrafish chemical models of human acute organophosphorus poisoning using liquid chromatography-tandem mass spectrometry[J]. Anal Bioanal Chem, 2018,410(6):1735-1748.
基本信息:
中图分类号:R595.4
引用信息:
[1]田飞,席祖洋,李茶香,等.胃内灌注治疗急性重度有机磷中毒患者的临床疗效及预后影响因素分析[J].巴楚医学,2023,6(04):35-41.
基金信息:
湖北省自然科学基金项目(No:2019CFB313)
2023-12-30
2023-12-30