| Background:Our department is mainly engaged in the treatment of poisoning,especially acute pesticide poisoning.Oral suicide was the most common cause of pesticide poisoning.Oral paraquat corrosion of oral mucosa,glyphosate poisoning of the digestive tract obstruction,often encountered in clinical work.With the improvement of the success rate of treatment for pesticide poisoning and the increase of the number of follow-up visits,more and more cases of digestive tract discomfort after pesticide poisoning have been reported.In the past two years,the number of cases admitted to our hospital with digestive tract obstruction after pesticide poisoning in our department has been on the rise.At present,there are few studies on digestive tract injury caused by pesticide poisoning.Gastroscopy can directly observe the real situation of the site under examination,and it is more capable of making pathological diagnosis of suspicious lesions,which is the preferred examination method for upper digestive tract lesions.Our department carries out a large number of gastroscopy examination for patients with pesticide poisoning,which has a great guiding role for the treatment of digestive tract after pesticide poisoning.Objective:Objective to explore the related factors of upper digestive tract injury caused by pesticide poisoning and its characteristics under gastroscope.Method:This study was a retrospective study,and the patients included in the study were patients treated with oral pesticide poisoning in qilu hospital of shandong university from December 2017 to April 2018.Patients with a clear history of oral pesticide were included.Patients with stable disease completed gastroscopy.The study was a retrospective study,and the patients included in the study were patients treated with oral pesticide poisoning in qilu hospital of shandong university from December 2017 to April 2018.Inclusion criteria:patients who had a clear history of oral pesticide;had completed gastroscopy after their condition is stable;had a detailed medical record(including general information,medical history,physical examination,treatment plan,etc.).Exclusion criteria:patients who were not hospitalized for pesticide poisoning;unstable patients due to pesticide poisoning or unstable patients with obvious gastrointestinal bleeding,perforation,esophageal mucosa shedding and other contraindications in gastroscopy;patients with a clear history of peptic ulcer before taking pesticide;patients with incomplete case records.All clinical data of the patients included in the study were collected.The clinical data were input into the database by using Excel statistical software,and statistical analysis was conducted by using SPSS 24.0.Results:(1)There were 39 cases of digestive tract injury complications,accounting for 75%of the patients.There were 39 cases(75%)of gastrointestinal bleeding,0 cases(0%)of gastrointestinal perforation,and 2 cases(4%)of gastrointestinal obstruction.(2)There were 50 cases of poisoning,36 cases(72%)of paraquat poisoning,6 cases(12%)of organophosphorus insecticide poisoning,3 cases(6%)of dioxane poisoning,2 cases(4%)of glyphosate poisoning,and 1 case(2%)of azoxone poisoning.The toxic dose was 37±29.15ml,and the range of digestive tract injury was 2.42±0.97.According to bivariate correlation analysis--spearman test,oral pesticide poisoning can lead to obvious digestive tract injury,and the dose of poison was significantly correlated with the scope of digestive tract injury(P<0.01)(3)Thirty-six patients with paraquat poisoning were poisoned at 31 ±15.6ml and the range of gastrointestinal injury was 2.5± 0.9.Bivariate correlation analysis-spearman test showed that paraquat oral administration could cause significant digestive tract injury,and paraquat dose was significantly correlated with the range of digestive tract injury(P<0.01).(4)Gastric lavage time of pesticide poisoning was 56.2±16.02min,and the range of digestive tract injury was 2.42±0.97.By bivariate correlation analysis--spearman test,there was no correlation between gastric lavage time of pesticide poisoning and damage scope of digestive tract mucosa(P=0.929).(5)The length of stay for paraquat poisoning was 18.2±4.2 days,and the range of gastrointestinal injury was 2.5±0.9.By bivariate correlation analysis--spearman test,the number of days in hospital for paraquat poisoning was significantly correlated with the extent of damage to the digestive tract mucosa(P=0.010).(6)There were 36 cases of paraquat poisoning,15 cases of digestive tract injury from the mouth to the cardia(42%),and 21 cases of digestive tract injury reaching the stomach and duodenum(58%),with the dose of 31±15.6ml.By non-parametric test-two independent samples test,taking cardia as the boundary,the dose of paraquat in the two groups showed significant difference(P<0.01).(7)The upper digestive tract of all patients showed varying degrees of damage at different sites.18 cases(36%)of them diagnosed as esophagitis:18 cases(100%)with chemical history according to medical history;5 of them had single or multiple longitudinal ulcers.13 of them had diffuse ulcers.Five cases were taken for esophageal pathology(28%),showing all of them had Acute and chronic mucosal inflammation.under the microscope,the rest of them shown the middle and upper esophageal mucosa was smooth;and Mucosal erosion and ulceration were found in the lower esophagus near the cardia.Four of them showed extensive congestion and erosion in the middle and lower esophageal entrance.Conclusion:There was a significant correlation between the scope of gastrointestinal mucosal injury and the amount of oral pesticide.There was no significant correlation between the duration of gastric lavage and the extent of digestive damage.The length of stay of paraquat poisoning patients significantly correlated with the extent of digestive tract injury.All patients with oral pesticide poisoning showed varying degrees of changes in different parts of the digestive tract injury.Oral pesticide poisoning,the main sites of esophageal injury:the lower esophagus near the cardia,the gastric antrum,and duodenal injury were mainly in the duodenal bulb.The pathological result was inflammatory cell infiltration. |
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