有機磷中毒病患之臨床特徵及其預後因子：某醫學中心五年回溯性分析

目的：有機磷農藥在我國被廣泛使用，品種達一百多種，多具有高強度之殺蟲力，對人畜影響亦大。根據衛生世界組織統計，每年約有3000萬人農藥中毒，其中以有機磷中毒者居多。有機磷中毒不論暴露途徑為何，均可能造成嚴重或不可逆之傷害，甚至死亡。本研究之目的將回溯性探討有機磷中毒病患之預後。方法：以回溯性，病歷回顧之方式進行研究分析，主要針對西元2008年到2012年，分析過去5年間某醫學中心中毒個案其有機磷農藥暴露的情況，利用病歷資料加以彙整，變項包含人口統計資料、醫療紀錄與相關病史、臨床特徵、治療過程與預後。以邏輯斯迴歸分析有機磷中毒病患與死亡之相關性。結果：共有46名有機磷農藥中毒病患收案，結果顯示年齡算數平均數為57 ± 18.7歲，個案以男性居多佔80.4%，需住加護病房者佔63.0%。此類病患中最常見之合併症為精神性疾病（32.6%），第二是心血管疾病（19.6%）。於5年研究中死亡個案有5人，總體致死亡率10.9%。以多變項分析，發現急性生理和慢性健康狀況評估第二版(Acute Physiology and Chronic Health Evaluation II, APACHE II)評估分數增加與加護病房之死亡率有統計學相關性(p = 0.031)。 結論：入住加護病房之APACHE II分數對有機磷中毒病患預後之預測有意義，未來需要一前瞻性研究為此提供更有力之實證。關鍵字：有機磷中毒、危險因子、死亡率、急性生理和慢性健康狀況評估第二版.

Background: Organophosphorus pesticides are widely used in Taiwan. These insecticides include more than one hundred varieties and have large impact on humans and animals. According to the statistical information of World Health Organization, there are about 30 million people with pesticide poisoning every year, in which the majority of these patients have organophosphate poisoning. Regardless of the exposure pathways in organophosphate poisoning, it is likely to cause serious outcomes or irreversible harm, even death. Therefore, the purpose of this study was to identify determinants of prognosis in patients with organophosphate poisoning. Methods: This retrospective study was conducted at a medical center. Consecutive patients having organophosphate poisoning who visited the Emergency Room between January 2008 and December 2012 were retrospectively enrolled. Data which were collected from the medical record of every patient included demographic information, details of medical history, clinical information, the treatment modalities and outcomes. Logistic regression was performed to determine independent correlates of mortality in patients with organophosphate poisoning.Results: Of the 46 patients with organophosphate poisoning recruited, their mean age was 57 ± 18.7 years, in which 80.4% were male and 63.0% were admitted to the intensive care unit (ICU). The most common comorbidities in these patients were psychiatric disorders (32.6%), followed by cardiovascular disorders (19.6%). During the study period, 5 of the 46 patients died, giving an overall case fatality rate of 10.9%. In multivariate analysis, an increased Acute Physiology and Chronic Health Evaluation (APACHE) II score (p = 0.031) was associated with ICU mortality.Conclusion: The APACHE II score on ICU admission is a significant prognostic indicator in patients with organophosphate poisoning. A further prospective study to strengthen this point is required.Key Words: Organophosphate poisoning, risk factor, mortality, APACHE II