急性百草枯中毒病人预后的影响因素分析

目的:探讨影响百草枯中毒病人预后的相关因素及血液灌流治疗清除炎症介质和百草枯的效果。方法:收集35例急性百草枯中毒病人的临床资料，均在常规治疗百草枯中毒基础上行HA230树脂血液灌流器治疗。根据病人预后情况将病人分为存活组和病死组，比较病人第一次血液灌流前后血浆百草枯浓度和血清白细胞介素-6、丙二醛水平及血清谷胱甘肽过氧化物酶、超氧化物歧化酶（SOD）活力变化，并分析病人血浆百草枯浓度、性别、年龄、服毒至第一次血液灌流时间和肝、肾、心肌损伤时间及血常规各指标与病人预后的关系。结果:35例病人中，存活20例，死亡15例，死亡率42.9%。2组病人服毒至第一次灌流时间和肝、肾、心肌损害时间及白细胞计数、中性粒细胞计数差异均有统计学意义（P<0.05~P<0.01）。与灌流前比较，2组病人第一次灌流后血浆百草枯浓度均明显降低（P<0.01），SOD活力均上升（P<0.05）；存活组病人灌流前后的血浆百草枯浓度均明显低于死亡组病人（P<0.01），而2组病人灌流前后的SOD、谷胱甘肽过氧化物酶、白细胞介素-6和丙二醛水平差异均无统计学意义（P>0.05）。结论:HA230树脂血液灌流能有效清除百草枯，并能改善SOD活力；血浆百草枯浓度、服毒至第一次灌流时间和肝、肾、心肌损害时间及白细胞计数、中性粒细胞计数是急性百草枯中毒预后的影响因素。

Analysis of the influencing factor of prognosis in acute paraquat poisoning patients

Objective:To investigate the influencing factor of prognosis,and effects of hemoperfusion removing the inflammatory mediators and paraquat in paraquat poisoning patients.Methods:The clinical data of 35 patients with acute paraquat poisoning were investigated.All cases were treated with conventional method combined with HA230 resin hemoperfusion.The patients were divided into the survival group and death group according to the prognosis.The paraquat concentration,levels of IL-6 and GSH-PX,and activities of MDA and SOD in two groups between before and after the first hemoperfusion were compared.The correlations of the paraquat concentration,sex,age,time of the poisoning to first time blood perfusion,time of the liver,kidney and cardiac injury and blood routine indicators with prognosis were analyzed.Results:Among 35 cases,20 cases survived,15 cases died,and the death rate was 42.9％.The differences of the time of the poisoning to first time blood perfusion,time of the liver,kidney and cardiac injury,white blood cell count and neutrophil count between two groups were statistically significant (P ＜ 0.05 to P ＜ 0.01).Compared with before hemoperfusion,the paraquat concentration in two groups after perfusion decreased significantly (P ＜ 0.01),the SOD activity increased significantly (P ＜0.01).The paraquat concentration in survival group before and after the first perfusion was significantly lower than that in death group,and the differences of the levels of SOD,GSH-PX,IL-6 and MDA in two groups between before and after perfusion were not statistically significant (P ＞ 0.05).Conclusions:HA230 resin hemoperfusion can effectively remove paraquat,and improve the activity of SOD.The plasma concentration of paraquat,time of the poisoning to the first perfusion,time of liver,kidney and cardiac injury,white blood cell count,neutrophil count are the prognosis influencing factors of acute paraquat poisoning.