| Objective:To observe the severe acute organophosphorus pesticide poisoning patients with features of multiple organ dysfunction and its risk factors, to explore its possible mechanism.Methods:All the observe subjects were selected from the admission patients of the Fifth Central Hospital of Tianjin (Jan 2007 to Dec 2010), admitted to the emergency department, clinical data more complete, the severe acute organophosphorus pesticide poisoning were 106 cases,60 cases were male (56.60%), women (46 cases,43.40%): Age 16～66 (33.31±13.07) years. Observe the patient's age, gender, poisoning the amount of time for poisoning to gastric lavage, poisoning to occur multiple organ dysfunction time, within 24 hours after admission the worst value of the index, calculated APACHEII score, And blood cholinesterase activity of organic phosphorus content, the determination of M-like symptoms observed, N-like symptoms, disturbance of consciousness, pulmonary rales, ECG, chest X-ray performance, wash juice volume, gastric lavage, the number of blood Purification of the application, the application of anti-cholinergic drugs (atropine or PHC treatment) differences in treatment related risk factors. According to whether multiple organ dysfunction occurred, patients were divided into multiple organ dysfunction group (n=42) and non-multiple organ dysfunction group (n=64); survival, according to 4 weeks, divided into death group (n=16) and survival Group (n=90). Comparison between the groups for statistical analysis software application SPSS 16.0, P<0.05 as significant criteria.Results:The moderate to severe AOPP occur in patients with MODS for the 42 patients, the incidence rate of 39.62%; survival of 90 cases,16 cases of death, mortality rate was 15.09%(16/106 cases); of which 15 cases occurred MODS group died, died 35.71%(15/42 patients), Oral toxicity of organophosphorus pesticides both ways, the occurrence of MODS starting up the lung and brain see, AOPP in patients with respiratory involvement was 32.08%(34/106 cases), central nervous system is 34.91%(37/106 cases). Involving the three organs of the mortality rate was 71.4%,6 mortality was 100% above the organ, and was statistically significant (P<0.01). Gastric lavage volume and rate of blood purification applications differ in prognosis (P<0.05), the prognosis of different treatment was no significant difference (P> 0.05), single-factor analysis of MODS occurs, in which the amount of poisoning, poisoning to wash Stomach time, M-like symptoms, N-like symptoms, respiratory rate, toxicity levels, ECG, chest X-ray performance, APACHEⅡscore, blood poison content, cholinesterase, blood urea nitrogen, blood gas analysis, blood Lactic acid, C-reactive protein, random blood glucose, gastric lavage volume, lavage the number of statistically significant difference in the area (P<0.05). The age, gender, body temperature, heart rate, mean arterial pressure, hematocrit, platelet count, total bilirubin, blood filtration rate, without regard anticholinergic drugs were no significant differences (P> 0.05), the Logistic regression analysis, with moderate to severe AOPP patients with MODS is an independent risk factor related to the amount of poisoning, blood lactate, and APACHEⅡscore.Conclusions:1-Acute organophosphate pesticide poisoning, severe is one of the important reasons for MODS.2. Acute organophosphorus pesticide poisoning patients with multiple organ dysfunction syndrome starting organ is the brain and lung, the most involved organ is the brain and lungs.3. Poisoning the amount of, blood lactic acid levels and APACHEⅡscore moderated to acute organophosphorus pesticide poisoning patients with multiple organ dysfunction syndrome were independent risk factors.4. Occurrence of multiple organ dysfunction syndrome in patients with acute organophosphorus pesticide poisoning mortality and organ dysfunction number of studies. |
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