| [Background] Acute pesticide poisoning has become a major public health problem worldwide, especially in developing countries. It is estimated that there are at least 3 million severe acute pesticide poisoning cases with high fatality rate in the world, and more than 300 thousands died of this in Asia rural area annually. Self-poisoning with pesticides is one of the most predominant means of suicide because it is easily accessible in rural area. Although we have done tons of work to control the fateful consequences of pesticides and have made great achievements, the task of prevention and control of pesticide poisoning is still under heavy burden. In the last decades, several diagnostic criteria and therapeutic principles of majority pesticides were established based on practices and experiences of treatment of pesticide poisoning. However, it is hard to be widely taken, especially in county-level hospitals. It is important for physican in county hospital to improve the diagnostic and treatment skill in order to further reduce the mortality of pesticide poisoning, because most of acute pesticide poisoning patients are treated in the county and/or township hospitals.[Object] We used retrospective analysis of acute pesticide poisoning cases to explore the potential impacting factors of acute pesticide poisoning treatment and methods of preventing acute pesticide poisoning. The questionnaire about knowledge, attitude, and practice (KAP) of acute pesticide poisoning treatment was taken to investigate the capability of dealing with acute pesticide poisoning among emergency physician in county-level hospitals.[Methods] we collected all acute pesticide poisoning cases in a county-level hospital from 2002 to 2007. According to the contents of the medical records, the key words were extracted and be entered datas base to characterize the basic information and treatment process of patients. Statistics analysis was performed using SPSS 16.0. The main methods included Chi-square test, Non-parametric test, correlation analysis, ROC curve, and non-conditional LOGISTIC regression model. [Results] Five hundred and fifty-one hospitalized cases of acute pesticide poisoning with 32 deaths were collected and the total fatality rate was 5.8%. Farmers were the main victims, which account for 83.4%.The poisoning differed in different age. Children's poisoning mainly caused by accident while adolescents' mainly caused by suicide. Suicide and occupational poisoning were responsible for the death in patients more than 30-year old. There was sex difference in these patients, in which more men than women in occupational poisoning, but it is contrary in non-occupational poisoning. There was also obvious seasonal difference.The poisoning patients and deaths were mainly resulted from organophosphorus pesticides. The fatality rate of suicide caused by organophosphorus pesticides was up to 15.6%.Compared with patients who were directly sent to the hospital, most transferred patients from low-level (township) hospital were non-occupational poisoning (P<0.05). In the patients who were directly sent to the hospital, the pre-hospital time of occupational poisoning was significantly longer than that of non-occupational poisoning patients (P<0.05). Within two hours after symptoms appeared, only 26.6% of occupational poisoning cases were sent to hospital. Patients caused by non-occupational pesticide poisoning were hospitalized more time than occupational pesticide poisoning patients. The hospitalization time of transferred patients from low-level (township) hospital was longer than those first visit to the hospital.42.7% of patients asked to leave hospital immediately when they felt improvement but actually they still need to be further treated.There was a negative correlation between cholinesterase activity and severity in oral organophosphate poisoning patients when they admitted to hospital, but the occupational poisoning patients didn't have such relationship. The overall proportion of moderate and severe of transferred patients was higher than that of directed patients in oral organophosphate poisoning(P<0.05). It was no significant difference in severity of different organophosphate pesticides. There was a trend that the severity increased with the dose of oral pesticides. Compared with patients whose pre-hospital time was more than 2 hours, the severity in those pre-hospital time was less than 2h didn't have much difference in non-occupational poisoning except patients caused by parathion.Logistic regression analysis showed that organophosphorus pesticides more likely lead to die than other pesticides. Parathion (including methyl parathion) and dichlorvos were the main organophosphorus pesticides, which fatality rate was 25.6% and 18.2%, respectively. Deaths caused by both of two pesticides account for 53.1%. The oral dose of organophosphorus pesticides would impact on fatality rate. The fatality rate of patients with oral dose of pesticides was more than 150ml was higher than that with less than 150ml. There was no significant difference among organophosphorus poisoning patients in different pre-hospital time (P<0.01). Ten patients of severe organophosphorus poisoning patients died, which accounted for 62.5%, and the fatality rate was up to 32.3% higher than that of mild and moderate poisoning patients. The fatality rate of patients after gastric lavage before admitted to hospital significantly higher than that without gastric lavage. It was no significantly different in fatality rate in patients whether they got atropine or oximes. The fatality rate of patients who got atropinization in whole treatment was significantly higher than that with no atropinization.The data indicated that parathion (including methyl parathion) was the most dangerous pesticide causing occupational pesticide poisoning. After stopping the use of parathion, the hazard of pesticides which caused occupational pesticide poisoning would be significantly decreased. Parathion was also the most dangerous pesticide which caused non-occupational pesticide poisoning, with its mortality up to 15.8%. If parathion was well controlled and not used, the mortality of non-occupational pesticide poisoning would be declined from 9.4% to 7.4%. The analysis of related literatures also gained the similar results.The score of knowledge(6.86±1.43) is low while the score of practice, attitude is relatively high (7.38±1.26,8.76±1.02, respectively) in low-level (township) hospital.The difference of score of knowledge was significant among physicians with different education backgrounds (P<0.05). Doctors with higher education background got more score.[Conclusion] This study indicated that the main factors which impact the prognosis of acute pesticide poisoning included the oral dose of pesticides, severity when patients admitted to hospital, gastric lavage or not, and so on. The occurrence of occupational pesticide poisoning and mortality of non-occupational pesticide poisoning might be decreased if the most dangerous pesticides were well supervised. It is necessary to train physicians for the knowledge and skill on the treatment of acute pesticide poisoning. |
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