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  • 學位論文

中台灣某醫學中心有機磷農藥中毒之研究

The Study of Organophosphate Pesticide Poisoning in a Medical Center in Mid-Taiwan

指導教授 : 許績男 林俊哲

摘要


目的:分析過去十二年間台灣中部地區某醫學中心有機磷農藥中毒、使用情況及變遷;試圖找出一些臨床數據可對患者的嚴重程度、併發症的發生及預後作為有效的預估。方法:本研究為回顧性研究,以病歷回顧的方式去進行研究分析。結果:本研究結果顯示有機磷農藥中毒個案數有逐年下降的趨勢,但仍對民眾健康造成很大的影響;其死亡率為9.8%,致死性併發症主要以吸入性肺炎、呼吸衰竭、敗血症和休克為主。分析存活個案與死亡個案之間的差異性,發現死亡個案中的格拉斯哥昏迷指數(Glasgow Coma Scale, GCS)分數較低、體溫偏低、呼吸急速和低收縮壓、白血球數偏高、動脈血檢查呈酸血症、高二氧化碳分壓及低血氧飽和度、急性生理和慢性健康狀況評估第二版 (Acute physiology and Chronic Health Evaluation, APACHE II)評估表的分數較高。當中昏迷指數、白血球數及剩餘鹼異常者,發生吸入性肺炎及呼吸衰竭的勝算比會比正常者高;再以邏輯斯迴歸分析,發現僅有異常的剩餘鹼值可以有效預測吸入性肺炎及呼吸衰竭的發生,雖然白血球數異常值也可有效預測呼吸衰竭的發生,但以異常的剩餘鹼值預測能力最佳。結論:剩餘鹼值可以有效預測吸入性肺炎和呼吸衰竭的發生,雖然有機磷農藥中毒的人口數有減少的趨勢,但自殺身亡的人數並沒有因而減少,反而持續的增加,可見自殺防治是目前相當重要的公共衛生問題。

並列摘要


Background: Investigate the usage and changing of organophosphate pesticide poisoning in the past twelve years in a medical center in Mid-Taiwan, and also determine the possible predictor for the severity, complication and prognosis. Methods: It is retrospective and chart review study. Results: Although the trend of the number of organophosphate pesticide poisoning is declining, it induces the large problems of public health. The mortality rate was 9.8 % in our study. The major fatal complications were aspiration pneumonia, respiratory failure, sepsis and shock. After investigate the data, we found that the patient had a higher-risk for mortality including the less score of Glasgow Coma Scale (GCS), lower body temperature, shortness of breath, lower systolic blood pressure, leukocytosis, acidosis, increased PaCO2, less oxygen saturation, and the higher score in Acute physiology and Chronic Health Evaluation (APACHE) II. If patients had abnormal values of Glasgow Coma Scale (GCS), White blood cell count (WBC) and Base excess (BE) has a tendency to develop aspiration pneumonia and respiratory failure. The logistic regression model showed that only BE is a indicator to predict the complication of aspiration pneumonia and respiratory failure. Conclusions: Our results show that the abnormal value of Base excess (BE) can be used to predict aspiration pneumonia and respiratory failure after organophosphate pesticide poisoning. Although the trend of organophosphate pesticide poisoning among the population is decreasing, the number of suicide has not reduced. Thus, suicide prevention is a very important public health problem.

參考文獻


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