摘要
目的分析通辽地区急性中毒患者的疾病谱,为本地区急性中毒规范化救治和制定毒原管控策略提供科学依据.方法采用回顾性横断面研究方法,通过医院信息系统(HIS)收集2018年1月1日至2022年12月31日内蒙古民族大学附属医院急诊急救中心(急诊科)收治的急性中毒患者的临床资料,包括性别、年龄、婚姻状况、地区分布、中毒途径、文化程度、中毒原因、季节分布、职业、既往病史、毒物种类、血液净化治疗患者数等,分析不同预后、不同性别、不同年龄、不同地区、不同季节、不同职业中毒患者的疾病谱特点,并观察不同中毒类型急性中毒患者治疗费用变化,采用Pearson相关性分析法分析性别、年龄、职业、既往史、中毒途径、中毒原因、治疗方式(洗胃、血液净化)、季节与住院总费用的相关性.结果共入组701例急性中毒患者,其中门诊治疗335例,住院治疗366例;男性和女性比例为1∶1.49;平均年龄(43.23±19.39)岁.①性别特点:5年内男性和女性中毒患者增长幅度差异无统计学意义(P>0.05);男性和女性急性中毒谱比较差异有统计学意义(χ^(2)=39.750,P=0.000);②年龄方面:急性中毒者多集中在30岁以上,平均(52.41±14.47)岁,其中60岁以上老年人最多[169例(24.11%)].不同年龄段患者中毒谱比较差异有统计学意义(χ^(2)=87.570,P=0.000);③既往史:既往病史对急性中毒的影响很大,本研究有既往病史者244例(34.81%),其中85例(34.84%)既往患有精神疾病,47例服用抗精神神经类药;④地区分布:科尔沁区急性中毒患者数最多(为340例),霍林郭勒市最少(5例),不同地区急性中毒患者数比较差异有统计学意义(χ^(2)=74.820,P=0.034);⑤季节特点:中毒月份集中在5、6、7、8、9月份,农药中毒集中在5、7、8月份,治疗性药品中毒为6、7、8和10月份;食物中毒则以8月、9月为主;⑥职业特点:农牧民急性中毒最多(占63.33%),离退休人员中毒患者最少(占1.71%),各职业中毒类谱比较差异有统计学意义(χ^(2)=86.130,P=0.000);⑦治疗费用:农药中毒和食物中毒人均费用较高;⑧相关性分析:相关性分析显示,治疗总费用与毒物类型、血液净化均呈明显正相关(r值分别为0.105、0.678,P=0.044、0.000),与季节呈明显负相关(r=-0.125,P=0.017),与性别、年龄、职业、既往史、中毒途径、中毒原因、洗胃无相关性(r值分别为0.077、0.078、-0.025、0.036、0.069、-0.073、0.004,均P>0.05);⑨毒物种类及预后:治疗药品(54.07%)和农药(37.95%)是最常见的毒物种类.治疗药品以镇静催眠药(32.72%)和解热镇痛药(22.69%)为主;农药中毒以除草剂(31.20%)、杀鼠剂(27.44%)、有机磷杀虫剂(24.81%)为主要毒物.中毒途径主要以消化道摄入为主(97.43%);治愈好转545例占(77.75%),未愈146例(20.83%),死亡10例(占1.42%);不同中毒类型总的预后差异无统计学意义(χ^(2)=10.380,P=0.239).血液净化治疗率27.39%.结论通辽地区急性中毒具有地域性特点;争吵、饮酒等应急刺激和焦虑、抑郁、睡眠障碍及脑血管病等精神神经疾病所致故意中毒是其重要致毒原因;减少易获得性对本地区毒原管控至关重要.
Objective To analyze the spectrum of poisoning diseases in the Tongliao area,and provide the scientific basis for standardized treatment of acute poisoning and formulation of toxin control strategies in this area.Methods A retrospective cross-sectional study method was conducted,clinical data of acute poisoning patients admitted to the emergency center(department of emergency)of Inner Mongolia University for Nationalities Affiliated Hospital from January 1,2018 to December 31,2022,were collected through the hospital information system(HIS),including gender,age,marital status,regional distribution,poisoning routes,cultural level,poisoning cause,seasonal distribution,occupation,past medical history,types of toxic drugs,and number of patients undergoing blood purification treatment.Analyze the disease spectrum characteristics of patients with different prognosis,gender,age,region,seasonal distribution and occupational poisoning,and observe the changes in treatment costs for acute poisoning patients of different types of poisoning.Pearson correlation analysis were used to analyze the correlation between gender,age,occupation,past medical history,poisoning routes,cause of poisoning,treatment methods(gastric lavage,blood purification),season,and total hospitalization expenses.Results A total of 701 patients with acute poisoning were enrolled,including 335 outpatients and 366 inpatients.The ratio of males to females was 1:1.49,and the average age was(43.23±19.39)years old.①Cender characteristics:there was no significant difference in the growth rate of male and female cases of sexual poisoning over the past 5 years(P>0.05).There was a statistically significant difference in the acute poisoning spectrum between males and females(χ^(2)=39.75,P=0.000);②In terms of age:acute poisoning patients were concentrated in those over 30 years old,with an average age of(52.41±14.47)years.Among them,169 cases(24.11%)over 60 years old were the most common,There was statistical significance in the comparison of poisoning spectra among patients of different age groups(χ^(2)=87.57,P=0.00);③Past medical history:previous medical history has a significant impact on acute poisoning.In this study,244 cases(34.81%)had a previous medical history,of which 85 cases(34.84%)had a history of mental illness.Among the 47 cases of poisoning caused by psychotropic drugs;④Regional distribution:Horqin District had the highest number of acute poisoning patients(340 cases),while Huolingol City had the lowest number(5 cases).There were statistically significant differences in the number of acute poisoning patients in different regions(χ^(2)=74.820,P=0.034);⑤Seasonal characteristics:poisoning months were concentrated in May,June,July,August,and September,pesticide poisoning was concentrated in May,July,and August,and therapeutic drug poisoning was concentrated in June,July,August,and October;food poisoning mainly occurs in August and September;⑥Occupational characteristics:farmers and herdsmen had the highest incidence of acute poisoning(63.33%),while retirees had the lowest incidence of poisoning(1.71%).There were statistically significant differences in the spectrum of occupational poisoning among different professions(χ^(2)=86.130,P=0.000);⑦Treatment cost:pesticide poisoning and food poisoning have the highest per capita cost;⑧Correlation analysis:correlation analysis showed that the total cost of treatment was significantly positively correlated with toxic drugs and blood purification(r=0.105,0.678,P=0.044,0.000),and negatively correlated with seasons(r=-0.125,P=0.017).It was not correlated with gender,age,occupation,history,poisoning routes,poisoning cause,and gastric lavage(r values were 0.077,0.078,-0.025,0.036,0.069,-0.073,0.004,all P>0.05);⑨Types and prognosis of toxins:therapeutic drugs(54.07%)and pesticides(37.95%)were the most common types of toxins.The main therapeutic drugs were sedatives and hypnotics(32.72%)and antipyretic analgesics(22.69%);pesticide poisoning was mainly caused by herbicides(31.20%),rodenticides(27.44%),and organophosphorus insecticides(24.81%).Poisoning routes mainly due to gastrointestinal intake(97.43%):545 cases(77.75%)were cured and improved,146 cases(20.83%)were not cured,and 10 cases(1.42%)died.There is no statistically significant difference in overall prognosis among different types of poisoning(χ^(2)=10.380,P=0.239).The blood purification treatment rate was 27.39%.Conclusion Acute poisoning in the Tongliao area has regional characteristics.The main causes were emergency stimuli such as arguments and alcohol consumption,as well as intentional poisoning caused by mental and neurological diseases such as anxiety,depression,sleep disorders,and cerebrovascular diseases.Reducing accessibility is crucial for the control of local toxins.
作者
宫宝泉
乌力吉吉日嘎
单迎春
Gong Baoquan;Uliji Jiriga;Shan Yingchun(Department of Emergency,Inner Mongolia University for Nationalities Affiliated Hospital,Tongliao 028050,Nei Monggol Autonomous Region,China;Department of Ultrasound,Inner Mongolia University for Nationalities Affiliated Hospital,Tongliao 028050,Nei Monggol Autonomous Region,China)
出处
《中国中西医结合急救杂志》
CAS
CSCD
北大核心
2023年第5期606-612,共7页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
关键词
通辽地区
急性中毒
回顾性横断面研究
Tongliao region
Acute poisoning
Retrospective cross-sectional study
