急性百草枯中毒患者预后影响因素的分析

目的：探讨影响百草枯中毒患者预后的因素，为其临床治疗提供救治依据。方法收集我院2011年3月至2013年3月百草枯中毒病例66例对其进行回顾性分析，其中死亡48例，存活18例；男26例，女40例。分析患者服药剂量、洗胃时间、APACHEⅡ评分、血清白细胞计数、血清肌酐、谷丙转氨酶、肌酸激酶同工酶与患者的预后关系，然后采用Logistic逐步向前回归筛选出有效指标，并通过ROC曲线评价其在百草枯中毒预后的诊断价值。结果两组患者在口服剂量、血白细胞计数、肌酐、谷丙转氨酶、肌酸激酶同工酶存在统计学意义。通过Logistic向前逐步分析后，口服剂量、APACHEⅡ评分进入Logistic回归方程。口服剂量、APACHEⅡ评分对患者死亡风险评价具有显著影响。不同时间段的APACHEⅡ评分对于患者预后的评价相关程度不同。对口服剂量、APACHEⅡ评分、口服剂量联合APACHEⅡ评分进行曲线下面积分析，其各自的曲线下面积为0.923、0.945、0.957。结论中毒剂量、APACHEⅡ评分可作为判断急性百草枯中毒病情严重程度及预后的可靠指标，口服剂量联合APACHEⅡ评分对预后评价更有意义。

Analysis the factors that affect the prognosis of the acute paraquat poisoning patients

Objective To analyze the different clinical factors of the acute paraquat poisoning patients. To provide the scientific basis for clinician providing proper care and predicting the outcome accurately. Methods The clinical data of 66acute paraquat poisoning patients was collected during the time from January 1, 2011 to December 30, 2012 in EICU of Shengjing hospital. 66 case divide into death group and the survival group, Their data include the information about age, gender, the time from the gastric lavage to poisoning, white blood cells, CK-MB, serum creatinine, ALT in blood APACHTII the time of hemoperfusion were retrospective analyzed. Which selected into logistic stepwise regression are analyzed through ROC curves to evaluate the diagnostic value. Results The amount of ingestion,white blood cells, CK-MB, serum creatinine, ALT, APACHEⅡ score between the death group and survival group reach the statistically significant（P〈0.05）. There are differences that different time of APACHEⅡ score to evaluate the death. The amount of ingestion, APACHEⅡ were selected through Logistic regression analysis. Their areas under the ROC were 0.923, 0.945, 0.957. Conclusion APACHEⅡ score,the amount of ingestion can be used as an effective indicator forth prognosis of paraquat poisoning patients. APACHEⅡ score combined the amount of ingestion has a higher value in the diagnosis of the risk of death.