急性百草枯中毒患者的预后因素分析

目的：探讨影响百草枯中毒患者预后的相关因素。方法：收集60例急性百草枯中毒患者的临床资料,均随机接受血液灌流联合血液透析（HP-HD）或血液灌流联合连续性静脉-静脉血液滤过（HP-CVVH）治疗,分析性别、年龄、服毒量、血浆百草枯浓度、服毒至入院时间、百草枯中毒严重指数（SIPP）、APACHEⅡ评分、血清尿素氮、肌酐、丙氨酸转氨酶、天冬氨酸转氨酶、肌酸激酶同工酶、钾、二氧化碳结合力、动脉血pH、动脉血氧分压、动脉二氧化碳分压、白细胞计数等指标与预后的关系。同时评价两种不同血液净化方式的疗效。结果：60例百草枯中毒患者病死率为70%（死亡42例）。存活组和死亡组比较,服毒量[（21.67±15.01）mL vs（86.07±36.49）mL]、血浆百草枯浓度[（6.82±3.58）mg/L vs（12.45±4.67）mg/L]、服毒至入院时间[（3.75±1.04）h vs（9.93±4.25）h]、SIPP[（15.78±8.71）h.mg/L vs（105.54±55.48）h.mg/L]、白细胞计数[（8.84±2.54）×109/L vs（13.42±2.99）×109/L]之间差异具有统计学意义（P〈0.05）。HP-CVVH组病死率低于HP-HD组（62.9%vs 80%）,但差异无统计学意义（P〉0.05）。结论：服毒量、血浆百草枯浓度、服毒至入院时间、SIPP、白细胞计数是影响急性百草枯中毒预后的因素。与HP-HD比较,HP-CVVH不能明显改善百草枯中毒患者的预后。

Analysis on prognosis factors of patients with acute paraquat poisoning

Objective： To investigate the related prognostic factors by retrospectively analyzing patients with acute paraquat poisoning. Methods： Sixty patients with acute paraquat poisoning were enrolled in this study, who underwent hemoperfusion combined hemodialysis （HP-HD） or hemoperfusion combined continuous venovenous hemofihration （HP-CVVH） randomly. The associations between prognosis and related factors including gender, age, amounts of ingestion, plasma paraquat concentration, hours since ingestion, severity index of paraquat poisoning （SIPP）, APACHE 11 score, serum BUN, serum creatinine, ALT, AST, CK-MB, K, CO2CP and pH arterial, the levels of PaO2, PaCO2, WBC count were investigated. And the efficacy of different blood purification modalities were evaluated. Results： The mortality rate was 70% （42 patients died）. Statistical significance were found between the survival and death group （P〈0.05）, with regard to the amounts of ingestion [（21.67±15.01 ） mL vs （86.07±36.49） mL], plasma paraquat concentration [（6.82±3.58） mg/L vs （12.45±4.67） mg/L], hours since ingestion [（ 3.75±1.04） h vs （9.93±4.25） h], SIPP [（ 15.78±8.71 ） h.mg/L vs （ 105.54±55.48 ） h.mg/L], WBC count [（ 8.84±2.54 ）×10^9/L vs （ 13.42±2.99 ） × 10^9/L]. The mortality rate of HP-CVVH group was lower than that of HP-HD group （62.9% vs 80% ）, but with no significant difference （P〉0.05）. Conclusion： The amounts of ingestion,plasma paraquat concentration, hours since ingestion, SIPP and WBC count are prognosis factors in acute paraquat poisoning. Compared with HP-HD, HP-CVVH can not improve the conditions of patients with acute paraquat poisoning.