急性百草枯中毒预后影响因素的临床分析

目的分析影响百草枯中毒病人预后的因素,研究改善患者预后的临床诊治方案。方法随机选取该院2010年11月1日至2012年1月31日期间急性百草枯中毒病例共49例,进行前瞻性观察研究,根据百草枯中毒严重程度指数(severity indexof paraquat poisoning,SIPP)高低分为低百草枯中毒严重程度指数组(A组)(≤20 h×mg.L-1)35例、高百草枯中毒严重程度指数组(B组)(20 h×mg.L-1)14例;按有无血液灌流分为血液灌流组26例、未行血液灌流组23例;根据患者病情转归分为存活组20例、死亡组29例。使用高压液相色谱法测定患者血清百草枯药物浓度,定期监测患者肝、肾功能、血气分析,并行肺部高分辨CT检查了解肺纤维化情况。分析百草枯血清药物浓度、脏器受损情况、肺纤维化、氧合指数等与患者预后的关系。结果 A、B两组比较,B组肺部纤维化范围大、脏器功能受损数目多,差异有统计学意义(分别P=0.022和P=0.01);B组氧合指数较低,差异有统计学意义(P=0.001)。存活组与死亡组比较,死亡组肺部纤维化范围较大、死亡组脏器功能受损数目多,差异有统计学意义(P0.05);死亡组氧合指数较低,差异有统计学意义(P0.05)。A、B两组比较,死亡率无统计学意义(P=0.081)。存活组与死亡组相比,服毒量、血清药物浓度、百草枯中毒严重程度指数差异均有统计学意义(P0.05)。血液灌流组与未行血液灌流组比较,存活率无统计学意义(χ2=0.882,P=0.348)。结论影响急性百草枯中毒患者预后的因素分别为服毒剂量、肺纤维化范围、氧合指数、脏器功能损害个数。提倡早期综合治疗,保护脏器功能,以提高中毒患者存活率。

Clinical analysis of prognostic factors of acute paraquat poisoning

Objective To analyze prognostic factors of acute paraquat（PQ） poisoning,to discuss the program to improve patients＇ prog- nosis. Methods A total of 49 acute paraquat poisoning cases were prospectively analyzed in our department from Nov. 1,2010 to Jan. 31,2012 ,randomly. According to severity index of paraquat poisoning（ SIPP）, the patients were divided into low severity index of pa- raquat poisoning group（ group A） （ n = 35 ） and high severity index of paraquat poisoning group（ group B） （ n = 14） ;and ,blood hamoper- fusion group and non-blood hamoperfusion group;survival group and death group respectively. A high performance liquid chromatographic （HPLC） method was used to determine plasma concentration of paraquat. Arterial blood gas analysis, hepatic function, renal function were monitored regularly in each group, and high-resolution CT was used to test regularly in every patients. The correlation between these test results and prognosis in patients were analyzed. Results Between group A and group B, there were significant differences in the range of lung fibrillation （ P = 0.022）, number of damaged function of organs （ P = 0.01 ） and oxygenation index （ P = 0.001 ）, whereas there was no statistical differences in mortality between group A and group B （ X2 = 3. 050, P = 0. 081 ）. Compared with the survival group, the death group had larger range of lung fibrillation, more organs function damaged, lower oxygenation index, higher intoxication dose ,higher plasma paraquat concentration, and higher SIPP（ P 〈 0.05 ）. There were no statistical differences in mortality between blood hamoperfusion group and non-blood hamoperfusion group（ X2 = 0. 882,P = 0. 348）. Conclusion The factors which influence acute pa- raquat poisoning prognosis are intoxicating dose,range of lung fibrillation, number of damaged function of organs and oxygenation index. Early comprehensive treatment and the organ-function protection could improve the survival rate of poisoning patients.