PSS评分对急性有机磷中毒病情评估及危险因素研究
摘要
目的:采用PSS评分方法评价急性有机磷中毒患者的病情严重程度及预后,探讨其临床应用价值;分析与急性有机磷中毒严重程度相关的危险因素。
方法:对本研究所属3家医院急诊科2006年10月至2008年2月收入的116例急性有机磷农药中毒患者进行前瞻性研究。入院时记录患者年龄、性别、毒物毒性、服药量、就诊时间、24小时内胆碱酯酶活力、中毒途径、慢性病、中毒意图、户籍,进行PSS评分,追踪患者的病情发展及结局。应用非条件Logistic回归分析,发现与急性有机磷中毒严重程度相关的危险因素。
结果:PSS值越高,则住院时间越长(P＜0.001),CHE越低(P＜0.01),并发症发生率越高(P＜0.05)。最终进入Logistic回归模型的危险因素有3个,依次是中毒意图(X_9)、服毒量(X_4)和24小时内胆碱酯酶活力(X_6)。
结论:入院时PSS评分高低能反映急性有机磷中毒患者的病情严重程度,PSS分值越高,并发症发生率越高,住院时间延长,病情越重,预后越差。PSS为急性有机磷中毒的临床病情分级提供了客观、统一的标准,在临床工作及科研中有一定的价值。胆碱酯酶活力是评价急性有机磷中毒病情严重程度的特异指标,PSS分值与入院24小时内胆碱酯酶活力呈负相关,PSS分值越高,胆碱酯酶活力越低。急性有机磷中毒患者中毒严重程度相关的危险因素依次为中毒意图、服毒量和24小时内胆碱酯酶活力。
OBJECTIVE:To access the possibility and practicability of Poisoning Severity Score(PSS)on acute organophosphorus pesticide poisoning(AOPP)patients,and analyze the risk factors correlated with severity of AOPP.
METHODS:Three hospitals in china were selected as study setting. The patients with AOPP admitted to emergency department were enrolled in study between October 2006 and February 2008.All the data were recorded including age,sex,toxicity of poison,dosage,interval time from poison to presentation to hospital,cholinesterase activity,route of intoxication,chronic disease,intention of poison and register when patients were on admission.All of 116 patients were evaluated with PSS instantly when they were sent to emergency department and were pursued on states of illness and observed on their prognosis under medical treatment.Logistic regression was used to find the risk factors correlated with severity of AOPP
RESULTS:Hospitalization duration,cholinesterase activity and incidence of complications in patients with different PSS varied markedly. There were three risk factors admitted to Logistic regression model, including intention of poison,poisonous dosage and cholinesterase activity in the first 24 hours.
CONCLUSIONS:The grade of PSS on admission can indicate the severity of AOPP.The complications incidence and hospitalization duration were increased with the higher grade of PSS,which indicated more serious pathogenetic condition and prognosis.PSS provided an objective and unified standard to access the severity of AOPP.And it was valuable for the clinic work and scientific research in AOPP.CHE was a special index for AOPP,and had a negative correction with PSS.The risk factors correlated with severity of AOPP included intention of poison, poisonous dosage and cholinesterase in the first 24 hours.
方法:对本研究所属3家医院急诊科2006年10月至2008年2月收入的116例急性有机磷农药中毒患者进行前瞻性研究。入院时记录患者年龄、性别、毒物毒性、服药量、就诊时间、24小时内胆碱酯酶活力、中毒途径、慢性病、中毒意图、户籍,进行PSS评分,追踪患者的病情发展及结局。应用非条件Logistic回归分析,发现与急性有机磷中毒严重程度相关的危险因素。
结果:PSS值越高,则住院时间越长(P＜0.001),CHE越低(P＜0.01),并发症发生率越高(P＜0.05)。最终进入Logistic回归模型的危险因素有3个,依次是中毒意图(X_9)、服毒量(X_4)和24小时内胆碱酯酶活力(X_6)。
结论:入院时PSS评分高低能反映急性有机磷中毒患者的病情严重程度,PSS分值越高,并发症发生率越高,住院时间延长,病情越重,预后越差。PSS为急性有机磷中毒的临床病情分级提供了客观、统一的标准,在临床工作及科研中有一定的价值。胆碱酯酶活力是评价急性有机磷中毒病情严重程度的特异指标,PSS分值与入院24小时内胆碱酯酶活力呈负相关,PSS分值越高,胆碱酯酶活力越低。急性有机磷中毒患者中毒严重程度相关的危险因素依次为中毒意图、服毒量和24小时内胆碱酯酶活力。
OBJECTIVE:To access the possibility and practicability of Poisoning Severity Score(PSS)on acute organophosphorus pesticide poisoning(AOPP)patients,and analyze the risk factors correlated with severity of AOPP.
METHODS:Three hospitals in china were selected as study setting. The patients with AOPP admitted to emergency department were enrolled in study between October 2006 and February 2008.All the data were recorded including age,sex,toxicity of poison,dosage,interval time from poison to presentation to hospital,cholinesterase activity,route of intoxication,chronic disease,intention of poison and register when patients were on admission.All of 116 patients were evaluated with PSS instantly when they were sent to emergency department and were pursued on states of illness and observed on their prognosis under medical treatment.Logistic regression was used to find the risk factors correlated with severity of AOPP
RESULTS:Hospitalization duration,cholinesterase activity and incidence of complications in patients with different PSS varied markedly. There were three risk factors admitted to Logistic regression model, including intention of poison,poisonous dosage and cholinesterase activity in the first 24 hours.
CONCLUSIONS:The grade of PSS on admission can indicate the severity of AOPP.The complications incidence and hospitalization duration were increased with the higher grade of PSS,which indicated more serious pathogenetic condition and prognosis.PSS provided an objective and unified standard to access the severity of AOPP.And it was valuable for the clinic work and scientific research in AOPP.CHE was a special index for AOPP,and had a negative correction with PSS.The risk factors correlated with severity of AOPP included intention of poison, poisonous dosage and cholinesterase in the first 24 hours.
引文
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