入院24小时内急性百草枯中毒患者预后的影响因素

目的]探讨急性百草枯中毒患者入院24 h内影响预后的危险因素.方法]收集2009年1月至2013年8月本院急诊科收治的急性百草枯中毒患者123例,根据预后分为存活组(46例)和死亡组(77例).比较两组患者一般情况(性别、年龄、口服百草枯剂量、服毒至洗胃和灌流的时间、灌流次数)、入院时血百草枯浓度、入院后24 h内最差急性生理功能和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、血气分析、血常规、尿常规、肝肾功能、心肌酶谱、电解质等生化指标,并分析影响预后的危险因素.结果]两组患者年龄比较差异均无统计学意义(P>0.05);存活组服毒量和入院时血百草枯浓度均明显低于死亡组(P<0.05);两组间服毒至灌流时间、灌流次数比较差异均无统计学意义(P>0.05).死亡组白细胞计数、丙氨酸氨基转移酶(ALT)和肌酐(Cr)水平显著高于存活组(P<0.05);死亡组患者K+水平低于存活组(P<0.05);两组患者门冬氨酸氨基转移酶(AST)、血清总胆红素(TBil)、尿素氮(BUN)、肌酸肌酶(CK)水平差异均无统计学意义(P>0.05).死亡组患者pH、HCO3-、PaO2、PaCO2均低于存活组(P<0.05),死亡组患者乳酸水平和APACHEⅡ评分均明显高于存活组(P<0.05).多因素Logistic回归分析结果显示,入院时血百草枯浓度、WBC、乳酸、服毒量、pH、K+均为影响急性百草枯中毒患者预后的危险因素.结论]入院时血浆百草枯浓度、WBC、乳酸、服毒量、pH、K+水平为急性百草枯中毒患者早期死亡的危险因素,对预后均有较高的预测价值.

Factors Influencing Prognosis of Patients with Acute Paraquat Poisoning within 24 Hours of Admission

Objective]To investigate the risk factors of acute paraquat poisoning in patients who were hospitalized within 24 hours.Methods]A total of 123 patients with acute paraquat poisoning were divided into survival group (n=46) and death group (n=77) from Jan.2009 to Aug.All patients were recorded and analyzed for general information (gender,age,oral dose of paraquat,time to gastric lavage and perfusion,number of perfusions),concentration of paraquat at admission,worst APACHE Ⅱ score within 24 hours,blood gas analysis,blood Routine,urine,liver and kidney function,myocardial enzymes,electrolytes and other biochemical indicators.The differences of the indexes between the two groups were compared and the prognostic risk factors were analyzed.Results]There was no significant difference in the age and the difference between the survival group and the death group (P>0.05).The survival dose and the concentration of paraquat in the surviving group were lower than those in the death group (P<0.05),but there was no significant difference between perfusion time and perfusion time.The levels of AST(Aspartate aminotransferase),Tbil(Serum total bilirubin),BUN(Urea nitrogen) and CK(Creatine kinase) in the survivors group and the death group were significantly higher than those in the survivors group (P<0.05);the levels of leukocyte,ALT(Alanine aminotransferase) and Cr(Creatinine) in the dead group were significantly higher than those in the survival group (P>0.05).The levels of pH,HCO3-,PaO2 and PaCO2 in the death group were lower than those in the survival group (P<0.05).The lactate level and APACHE Ⅱ score of the death group were higher than those of the survival group (P<0.05).Multivariate Logistic regression analysis showed that the concentration of blood paraquat,WBC,lactic acid,toxin,pH and K+ were the risk factors of acute paraquat poisoning.Conclusion]The levels of blood paraquat,WBC,lactic acid,toxication,pH and K+ were the risk factors of early death in patients with acute paraquat poisoning,and with the high prognostic value.