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目的探讨与急性有机磷农药中毒(AOPP)所致上消化道出血相关的临床因素,寻找防治上消化道出血的有效措施。方法选择2005年1月至2009年9月中南大学湘雅医院急诊科收治的重度AOPP患者49例,根据临床症状分为上消化道出血组(A组,26例)和非上消化道出血组(B组,23例),观察上消化道出血发生的时间、次数、原因,两组血糖、急性生理学及慢性健康状况评分Ⅱ(APACHEⅡ评分)、血清胆碱酯酶及预后的差异。结果 AOPP致上消化道出血的原因依次为毒物损伤胃黏膜、洗胃损伤、应激性溃疡;A组APACHEⅡ评分明显高于B组,血清胆碱酯酶明显低于B组;APACHEⅡ评分与上消化道出血呈正相关,血清胆碱酯酶与上消化道出血呈负相关。结论 APACHEⅡ评分及血清胆碱酯酶都可用于反映AOPP时上消化道出血的发生情况。
Objective To investigate the clinical factors associated with upper gastrointestinal hemorrhage caused by acute organophosphorus pesticide poisoning (AOPP) and to find effective measures to prevent upper gastrointestinal bleeding. Methods Forty-nine patients with severe AOPP admitted to the Emergency Department of Xiangya Hospital of Central South University from January 2005 to September 2009 were divided into upper gastrointestinal bleeding group (group A, n = 26) and non-upper gastrointestinal bleeding group according to clinical symptoms (Group B, 23 cases). The time, frequency and cause of upper gastrointestinal bleeding were observed. The blood glucose, acute physiology and chronic health status score Ⅱ (APACHEⅡ), serum cholinesterase and prognosis were observed. Results The causes of upper gastrointestinal bleeding caused by AOPP were poisonous gastric mucosa, gastric lavage injury and stress ulcer. The APACHEⅡscores in group A were significantly higher than those in group B, and the levels of serum cholinesterase were significantly lower than those in group B. The APACHEⅡscore and Gastrointestinal bleeding was positively correlated, and serum cholinesterase was negatively correlated with upper gastrointestinal bleeding. Conclusion APACHE Ⅱ score and serum cholinesterase can be used to reflect the occurrence of upper gastrointestinal bleeding when AOPP.