呼吸机治疗急性有机磷中毒中间期肌无力综合征成功脱机多因素分析

摘要

目的：探讨呼吸机治疗急性有机磷中毒中间期肌无力综合征（ IMS）影响脱机的相关因素，为临床判定脱机时机提供参考依据。方法回顾性分析2005-09～2012-07收住我院经洗胃、阿托品、氯磷定、抗感染及呼吸支持等综合治疗且临床资料完整的急性有机磷中毒并发IMS患者80例，根据脱机成功与否分为两组：脱机组和未脱机组，对照分析两组患者临床资料，采用Logistic回归分析其预后相关因素。结果80例IMS患者中脱机组66例，未脱机组14例，两组患者比较，脱机组中毒至抢救时间较短（ P＝0．001），且入院时APACHEⅡ评分明显低于未脱机组（P＝0.001）；脱机组患者拥有较低的血白细胞计数（WBC）（P＝0．032）、肌酸激酶（CK）（P＝0.001）及肌酸激酶同工酶（CK-MB）（P＝0．001），脱机组患者脱机前检测全血胆碱酯酶（ChE）浓度明显高于未脱机组（P＝0．004）。并发肺部感染患者更容易导致脱机失败（P＝0．036）；脱机组患者氯解磷定平均每日用量（P＝0．026）、平均血液灌流时间（P＝0.04）明显高于未脱机组，脱机组阿托品平均用量低于未脱机组（P＝0．001）。血CK升高为急性有机磷中毒IMS患者脱机的危险因素；而较高的全血ChE及充足的血液灌流为IMS患者脱机的保护性因素。结论在综合治疗基础上充分血液灌流治疗，加强气道管理以减少肺部感染，入院时较低的APACHEⅡ评分及脱机前监测全血ChE活力、CK值、血WBC，有助于急性有机磷中毒IMS患者的成功脱机。%Objective To analyze relevant factors on weaning from mechanical ventilation in patients with intermediate syndrome ( IMS) of acute organophosphate poisoning ( AOPP) , and to provide the basis of the time of weaning .Methods Eighty cases with IMS of AOPP in our hospital from September 2005 to July 2012 were included in this retrospective study .They were given combined treatment (gastric lavage, atropine, pralidoxime, chloride, anti -infection, respiratory support and so on) and were divided into two groups:the weaning group and the weaning failure group .Contribution of the factors to prognosis was determined by multivariate analysis with Logistic regression .Results There were 66 cases in the weaning grope , 14 cases in the weaning failure grope .There were significant differences between the weaning group and the weaning failure group , including time window of poisoning (P=0.001) and APACHEⅡ (P=0.001).There were also significant differences in WBC (P=0.032), CK (P=0.001) and CK -MB (P=0.001).The ChE activity of the weaning group was apparently higher than the weaning failure group ( P =0.004 ).There were significant differencesbetween two groups in pulmonary infection (P=0.036), the average dose of pralidoxime chloride (P=0.026), hemoperfusion time (P=0.04) and the dose of atropine (P=0.001).High level of CK was independent predictors of fatality in weaning grope;high level of ChE activity and enough hemoperfusion were protective factors . Conclusion In the base of comprehensive treatment , using full of hemoperfusion , enhancing the administration of airway to decrease pulmonary infection , the APACHEⅡscore of admission, ChE activity and CK , WBC before weaning are helpful to successful weaning from ventilator for AOPP.