重症评分在治疗有机氟气体中毒致多器官衰竭患者中的作用
Critical Scoring Systems in the Treatment of Multiple Organ Dysfunction Due To Organic Fluorine Gas Poisoning
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摘要: 目的 了解重症评分系统对治疗有机氟气体中毒导致多器官功能衰竭患者的作用.方法 采集3例工业有机氟气体中毒患者的临床病例,包括临床症状、体征、诊疗经过、预后,动态随访APACHEⅡ、SOFA、MODS评分,比较不同患者的差异并分析与预后相关性.结果 3例患者首日APACHEⅡ评分为19~26分;1例患者三项评分持续升高,构成比例不同,提示有不同脏器相继出现功能衰竭,预后不良;另2例患者3项评分进行下降,患者存活出院,无远期并发症.结论 可以采用多个评分系统综合评价有机氟气体中毒导致多器官功能衰竭患者转归病程,强调对此类患者给予整体评估和个体化治疗.有待建立有机氟中毒特异性的重症评分系统.Abstract: Objective To investigate the value of critical scoring system in the treatment of multiple organ dysfunction after exposure to poisoning by analyzing 3 cases of industrial organic fluorine gas poisoning. Methods Clinical data of symptoms,signs,treatments,outcome and the changes in the scores as APACHEⅡ,SOFA,MODS were collected,the differences among the patients were compared and the relevance was analyzed. Results The first APACHEⅡwas 19-26. Scores of case 1 in the three scoring systems constantly increased and different components were found, with the suggestion of sequential organ dysfunction. Other two patients' scores decreased and survived without complications. Conclusion Multiple critical scoring systems can be used to evaluate the outcome of multiple organ dysfunction due to organic fluorine gas poisoning. System evaluation and individualized treatment are both important. More studies can help to set up a special critical scoring system.
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[1]翁雪梅,闻建范,王洁群.发急性有机氟吸入及中毒临床诊治体会[J].职业卫生与应急救援,2010,28(4):222-223. [2]翁金龙.急性重度有机氟中毒致多脏器功能障碍临床分析[J].职业卫生与应急救援,2003,21(4):210-220. [3]肖会云,王应忠.急性重度有机氟中毒预后影响因素分析及临床治疗策略研究[J].北方药学,2012,9(10):40-41. [4]耿平,徐继扬,夏仲芳,等.重度急性有机氟吸入性中毒早期临床危险因素分析[J]中国中西医结合急救杂志,2014,21(5):345-349. [5]GBZ66-2002,职业性急性有机氟中毒诊断标准[S]. [6] [6]RANIERI V M,RUBENFELD G D,THOMPSON B T,et a1.Acute respiratory distress syndrome:the Berlin Definition[J].JAMA,2012,307(23):2526-2533. [7] [7]KNAUS WA.APACHE 1978-2001.The development of a quality assurance system based on prognosis[J].Archives of Surgery,2002,137(1):37-41. [8] [8]MARSHALL J C,COOK D J,CHRISTOU N V,et al.Multiple organ dysfunction score:a reliable descriptor of a complex clinical outcome[J].Crit Care Med,1995,23(10):1638-1652. [9] [9]VINCENT J L,MORENO R,TAKALA J,et al.The SOFA(Sepsis-related Organ Failure Assessment)score to describe organ dysfunction/failure.On behalf of the working group on sepsis-related problems of the European society of intensive care medicine[J].Intensive Care Med,1996,22(7):707-710. [10] [10]PERES B D,MELOT C,LOPES F F,et al.The multiple organ dysfunction score(MODS)versus the sequential organ failure assessment(SOFA)score in outcome prediction[J].Intensive Care Med,2002,28(11):1619-1624. [11]孙杰,贾芸玲,孙炳新.急性有机氟化物损伤的临床救治体会[J].职业卫生与应急救援,2006,24(1):51. [12]王莹.急性有机氟中毒的特点化工劳动保护[J].工业卫生与职业病分册,1997,18(5):217-220. [13]丁钺,唐桂芬,邹建华,等.急性有机氟化合物中毒患者的肺功能随访[J].中国工业医学杂志,1995,8(2):87-88. [14]耿平,夏仲芳,叶靖,等.急性有机氟气体中毒患者呼吸系统损害的特点分析[J].临床急诊,杂志,2014,15(2):71-74. [15]马爱闻,徐继扬,徐敏.有机氟中毒致中毒性肺水肿的临床救治[J].临床荟萃,2012,27(3):243-245. [16] 翁雪梅,闻建范,王洁.有机氟吸入及中毒临床诊治体会职业卫生与应急救援,2010,28(4):222-223. [17]刘进,刘军,富昭,等.有机氟中毒性肾病的研究[J].国外医学医学地理分册,2004,25(4):189-191. [18]刘进,刘军,富昭,等.有机氟中毒对心肌的损害[J]国外医学医学地理分册,2004,25(3):143-145. [19]刘进,刘军,刘宏亮,等.急性有机氟中毒性脑病的临床研究[J].国外医学医学地理分册,2003,24(4):190-192. [20]耿秋.明急性重度有机氟中毒脑病临床与CT检查(附16例报告)[J].中国医师杂志,2001,3(增刊):33-34. [21]卢翠莲,张海澄,刘丹,等.不同类型危重评分的临床对比研究[J].临床心电学杂志,2011,20(3):198-200. [22]宫能凯,李倩.常用危重症评分在临床应用的研究进展[J].右江民族医学院学报,2015,37(6):855-857. [23] 刘谦民.重症评分的临床应用进展[J].医学信息,2012,25(6):126-127. [24]唐华平,方海云,蒲云学.常见急危重症评分与颅脑创伤死亡预测分析[J].创伤外科杂志,2015,17(5):455-458. [25]崔虎军,信维强,谭艳芬.3种危重评分系统对心脏大血管外科术后患者预后评估的分析[J].中国危重病急救医学,2004,16(11):673-676. [26]杨冬梅,刘志,于红玲,等.序贯器官衰竭评分对血液灌流治疗急性重度有机磷中毒的临床评价[J].实用医学杂志,2015,31(5):776-778. [27]刘伟,马涛,刘志.序贯器官衰竭评分对急性中毒病情及预后的评价[J].中华急诊医学杂志,2008,17(6):591-594. [28]方婷婷,肖江琴,王海燕,等.MEWS、MEWS+和APACHEⅡ在急性中毒危重患者预后判断中的应用[J].山东医药,2015,55(47):14-16. [29] 杨冬梅,杨秀峰,李长浩.REMS评分与APACHEⅡ评分对预测急诊中毒患者预后的临床意义[J].中外健康文摘,2012,9(2):204-205. [30]施小燕,洪玉才,江观玉,等.中毒严重度评分和APACHE-Ⅱ在中毒评估应用中的对比研究[J].中华急诊医学杂志,2007,16(1):65-67.
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