A Clinical Study Of Nephritic Injure In Acute Organophosphorous Insecticides Poisoning

Objective To investigate the clinical meaning of changesabout blood flows, ion, renal function, hemolipid, urine protein,hematuria etc in acute organophosphorus insecticidespoisoning(AOPP) , and explore the pathogenesis of kidney hurt.Methods Thirty patients who were suffering from acuteorganophosphorus toxicosis orally were in Group B, they wereall matching the diagnostic standard of AOPP. They weresuffering from the disease which have the same analysis indexchange were all precluded. Thirty health out-patients were inGroup A. According to the AOPP diagnostic rankingstandard ,The patients in group B were divided into group C(mild poisoning) and group D(midst severe poisoning). Afterexamming WBC,RBC,HCT,RDW,PLT,Na+,K+,BUN,Scr,CO2CP,CHOL,TG,the blood cell number of urine, andPRO, we analysis all datum between group A and B,A and C,A and D,C and D.then compute and compare the positive rateof PRO,the blood urine and percentage of renal functioninadequacy in group B,C,D . Result Compared group A and B,the results have statistic meaning. The index of WBC,RDW,PLT,BUN,SCR of blood,RBC of urine all step up. The RBC,HGB,HCT,CHOL,TG,Na, K,CO2CP of blood all stepdown. Compared A and C, The index of WBC,RDW,PLT,TG,Na, K and RBC of urine have statistic meaning. ButBUN,Scr,CO2CP have no statistic meaning;Compared groupA and D, The other index change excluded blood K+ werelikewise the compared result of group A and B. Comparedgroup C and D, the level of Na+ goes down, and BUN, SCR,urine RBC goes up;the other indexes have not statistic meaning.The positive rate of PRO is 63%, the positive rate of bloodurine is 73%. The positive rate of PRO in group D is 92%, thepositive rate of blood urine is 92%. Then they are 42%,59%respectively in group C. The rate of group D is higher thangroup C, And the difference has statistic meaning. Thepercentage of renal failure is 23% in the patients of AOPP, andall belong to the heavy degree. They account for 54% in groupD. Conclusion The kidney of the patients has been damagedmore or less, and the more ponderosus renal damage , the moresevere the poisoning is. The patients have mild damage onlymanifest the semiquatitation positive urine protein and thepositive blood urine, because the kidney has powerfulcompensated function, The GFR has not decrease manifestly.So the BUN and SCR of mild rena damage have no markedchange. With the poisoning aggravate, the renal damageaggravate, the level of BUN and SCR step up obviously, andthe kidney damage emerge. The patients of AOPP have alsoabnormality of ion ,the blood flow, the acid-base balance andlipometabolic。The mechanism and influential factor of renaldamage as following: (1)The direct kidney injury oforganophosphorus insecticides poisoning;(2)the mobile effectof the blood flow (3) the effect of acid-base imbanlance,ionindiscrimination (4) the effect entero endotoxemia. Treatmentcounterplan: The kidney damage of AOPP can recover quicklywith the treatment, In order to prevent the renal damageaggravate, The measure must be adopted: (1)discharge theunabsorbed organophosphorus toxicosis in stomach andintestines;(2) improve excreation, rectify the low blood capacityand keep the balance of sour, alkali, electrolyte and water, applyof small amount of dopamin;(3) use anticholine drugs andreactive drugs correctly;(4) usage of antibiotics;(5) the supportof mechanical ventilation;(6) inputs the fresh blood, bloodplasma displacement;(7) prevent the complications andmultiple organs dysfunctional syndrome (MODS).