急性百草枯中毒早期多器官损害的临床分析与预警作用  

Clinical Analysis of Multiple Organ Damage in Early Stage of Acute Paraquat Poisoning and the Implication in Prognosis

作　　者：高渝峰[1] 史晶[1] 刘青[1] 廖晓星[2] 

机构地区：[1]广州市第十二人民医院广州市化学中毒救援中心急诊科,广州510620 [2]中山大学附属第一医院急诊科,广州510080

出　　处：《热带医学杂志》2010年第3期294-296,共3页Journal of Tropical Medicine

基　　金：广州市医药卫生科技项目(No.2009-YB-111)

摘　　要：目的分析急性百草枯中毒患者早期心、肝、肾功能变化,探讨其对预后的影响。方法用酶法分别检测68例急性百草枯中毒患者(中毒时间<24h)入院时心肌酶、血清谷丙转氨酶(ALT)、总胆红素(TBil)、血清尿素氮(Bun)、肌酐(Cr)以及检查胸片;统计患者中毒剂量和中毒时间,并进行APACHEⅡ评分。依据临床结局分为猝死组(生存时间≤24h组)和非猝死组(生存时间>24h组)。结果中毒患者猝死组与非猝死组的中毒时间、中毒剂量比较差异有统计学意义(P<0.05,P<0.01),两组患者年龄、性别比、APACHEⅡ评分比较差异无统计学差异意义(P>0.05);猝死组心肌酶、血清ALT、TBil、Cr均显著升高,与非猝死组比较差异有统计学意义(P<0.01)。结论百草枯中毒猝死患者早期出现严重的中毒性心、肝、肾损害,救治过程中应强调重要器官保护并及早干预;中毒后血清心肌酶活性的显著升高可能是发生猝死的一个预警指标。Objective To analyze the early stage of acute paraquat poisoning in patients with cardiac,liver and renal function changes and their implication in prognosis.Methods 68 cases of patients with acute paraquat poisoning（poisoning time 〈24 h） were diagnosed for the levels of myocardial enzymes,admission serum alanine aminotransferase（ALT）,Total bilirubin（TBil）,Blood urea nitrogen（Bun）,Creatinine（Cr） and chest X-ray.The toxic dose and exposure time were recorded and convert to APACHE II score.Based on clinical outcomes the patients were divided into sudden cardiac death group（survival time ≤24 h group） and non-sudden cardiac death group（survival time 〉24 h group）.Results Poisoning in patients with sudden death group and non-sudden cardiac death group the time of exposure and poisoning doses have significant differences（P〈0.05,P〈0.01）,but not for the age,sex ratio and APACHE Ⅱ score（P〉0.05）.The serum levels of ALT,TBil and Cr in the sudden cardiac death group were significantly increased when compared with those in the non-sudden cardiac death group（P〈0.01）.Conclusion Early stage of paraquat poisoning demonstrated myocardial,liver and kidney damage.Protection of the major organs and early intervention should be emphasize in the recurring process.The elevation of serum myocardial enzyme could be the warning symptom of sudden death.

关 键 词：百草枯 中毒 心肌损害 肝损害 肾损害 

分 类 号：R595.4[医药卫生—内科学]