急性百草枯中毒患者预后影响因素的研究  

Study on the prognosis of patients with acute paraquat intoxication

作　　者：刘鹏[1] 何跃忠[2] 王浩春[2] 李光[2] 张成岗[3] 张锡刚[2] 孟庆义[1] 

机构地区：[1]中国人民解放军总医院急诊科,北京100853 [2]中国人民解放军总医院附属医院急诊科,北京100853 [3]军事医学科学院放射与辐射医学研究所,蛋白质组学重点实验室

出　　处：《中华劳动卫生职业病杂志》2011年第3期212-215,共4页Chinese Journal of Industrial Hygiene and Occupational Diseases

基　　金：科技部科技基础性工作专项项目（2006FY230300）;解放军总医院科技创新基金（200800684）

摘　　要：目的探讨影响急性百草枯中毒患者预后的因素。方法对111例急性百草枯中毒患者早期血浆和尿液中百草枯浓度、血液白细胞计数、肝肾功能、血清淀粉酶、电解质及动脉血气分析进行回顾性分析。结果111例中毒患者存活43例，死亡68例，病死率为61．3％；血浆中百草枯浓度≤8．0μg／ml，尿液中百草枯浓度≤276．0μg／ml的中毒患者可能存活，但血浆中检测不到百草枯的中毒患者也可发生死亡。生存组患者血浆中百草枯、尿液中百草枯浓度[（0．82±1．70）、（28．12±51．17）μg／ml]明显低于死亡组[（9．32±12．04）、（384．53±597．93）μg／ml]，差异有统计学意义（P〈0．01）；死亡组外周血白细胞总数、血清肌酐含量、天冬氨酸转氨酶活力、血清淀粉酶活力明显高于生存组，差异有统计学意义（P〈0．05，P〈0．01）；死亡组易于出现代谢性酸中毒。logistic回归分析表明，百草枯中毒患者的生存率与血浆、尿液中百草枯浓度、外周血白细胞总数、肌酐、BE值相关。结论高浓度的血浆、尿液中百草枯，白细胞增高、肾功能障碍及代谢性酸中毒是影响百草枯中毒患者预后的重要因素。Objective To study the correlation factors of acute paraquat intoxication prognosis. Methods The early paraquat concentration in plasma and urine, leukocyte count, hepatic and renal function, amylase, electrolyte and the parameters of arterial blood gas were analyzed retrospectively in 111 patients with acute paraquat intoxication. Results 43 cases（38.7%） of all the 111 patients survived and the other 68 cases （61.3%） died. The patient, whose paraquat concentration was not more than 8.0 μg/ml in plasma and 276.0μg/ml in urine,could survive. But some patients could die,only if there was no paraquat found in plasma.The paraquat levels in plasma and urine were significantly lower in survivors [（0.82±1.70）,（28.12±51.17） μg/ml] than in nonsurvivors [（ 9.32 ± 12.04 ）, （ 384.53 ±597.93 ） μg/ml, respectively] （ P〈0.01 ）. The levels of leukocyte count, serum creatinine, aspartate aminotransferase （AST）, and amylase were significantly higher in nonsurvivors than in survivors （P〈0.05,P〈0.01）. In addition, metabolic acidosis was easier to appear in nonsurvivors.The multiple logistic regression analysis indicated that the paraquat concentration in plasma and urine, leukocyte count, creatinine and base excess were all related to survival. Conclusion The higher paraquat concentration in plasma and urine, leucocytosis, renal dysfunction and metabolic acidosis are all important factors for the prognosis of paraquat intoxication.

关 键 词：百草枯 中毒 预后 

分 类 号：R595.4[医药卫生—内科学]