急性百草枯中毒早期死亡相关因素分析  

An analysis of relevant factors of early death in acute paraquat poisoning

作　　者：才权 刘志[1] 

机构地区：[1]中国医科大学附属第一医院急诊科,辽宁沈阳110001

出　　处：《中华危重病急救医学》2014年第6期379-382,共4页Chinese Critical Care Medicine

基　　金：辽宁省科技计划项目（2013225303）

摘　　要：目的 寻找判断急性百草枯（PQ）中毒患者早期（72 h内）死亡的相关临床指标.方法 回顾性分析中国医科大学附属第一医院急诊重症监护病房（EICU）收治的93例急性PQ中毒死亡患者的临床资料,根据中毒后是否在72 h内死亡分为两组,记录两组患者的性别、年龄、服毒量、尿中PQ浓度、每次灌流后尿中PQ浓度的降低率;中毒后24 h内血白细胞计数（WBC）、淋巴细胞计数、动脉血气分析值,血K＋、Na＋、Cl-,以及血清淀粉酶、脂肪酶、总胆红素、肌钙蛋白Ⅰ、肌酸激酶（CK）、尿素氮、血肌酐的最差值;采用Spearman相关分析尿中PQ浓度与服毒量的相关性;用受试者工作特征曲线（ROC曲线）分析各指标对中毒早期死亡的预测价值.结果 93例急性PQ中毒患者72 h内死亡19例,早期病死率为20.4％.与非早期死亡组比较,早期死亡组服毒量（mL：133.4±108.8比58.6±40.0,t=3.145,P=0.002）、尿中PQ浓度[mg/L：16.34（11.87,96.76）比4.46（1.21,12.78）,Z=-3.422,P=0.001]、WBC（×109/L：22.63±9.72比14.95±8.39,t=3.446,P=0.001）、动脉血乳酸[Lac（mmol/L）：6.7（2.2,12.1）比1.9（1.1,3.4）,Z=-3.294,P=0.001]均明显升高,第一次血液灌流后尿中PQ浓度降低率[（38.40±15.63）％比（67.59±27.87）％,t=2.945,P=0.004]、动脉血二氧化碳分压[PaCO2（mmHg,1 mmHg=0.133 kPa）：28.7±9.3比34.8±6.7,t=-3.245,P=0.002]明显降低,其余指标差异均无统计学意义.服毒量与尿中PQ浓度呈显著正相关（r=0.450,P＜0.001）.ROC曲线显示,尿中PQ浓度、WBC、Lac预测PQ中毒早期死亡价值较大[尿中PQ浓度的曲线下面积（AUC）为0.806,95％可信区间（95％CI）为0.699～0.913,截断值为11.64 mg/L时,敏感度为84.6％,特异度为71.4％;WBC的AUC为0.734,95％CI为0.569 ～ 0.899,截断值为15.94×109/L时,敏感度为69.2％,特异度为76.8％;Lac的AUC为0.729,95％CI为0.568 ～ 0.891,截断值为1.95 mmol/L时,敏感度为84.6％,特异度为42.9�Objective To determine the clinical indicators of early death （within 72 hours） in patients with acute paraquat poisoning.Methods The data of 93 acute paraquat poisoning patients admitted to emergency intensive care unit （EICU） of the First Hospital of China Medical University were retrospectively analyzed.The patients were divided into two groups according to whether they died within 72 hours or not.The gender,age,poison dose,paraquat concentration in urine,reduction of paraquat amount in urine after each hemoperfusion,and the worst value of white blood cell （WBC） count,lymphocytes count,arterial blood gas analysis,blood K ＋,Na＋,Cl-,and serum amylase,serum lipase,serum total bilirubin,troponin Ⅰ,creatine kinase （CK）,blood urea nitrogen,serum creatinine within 24 hours after poisoning were compared.Spearman correlation analysis was used to analyze the correlation between paraquat concentration in urine and the dose of paraquat.The predictive value of each indicator at death in early stage of poisoning was analyzed with receiver operating characteristic curve （ROC curve）.Results Nineteen patients in the group of those died in early stage of poisoning （within 72 hours） resulted in a mortality rate of 20.4％.Compared with non-early death group,in early death group,the value of poison dose （mL：133.4 ± 108.8 vs.58.6 ± 40.0,t=3.145,P=0.002）,paraquat concentration in urine [mg/L：16.34 （11.87,96.76） vs.4.46 （1.21,12.78）,Z=-3.422,P=0.001],WBC （× 109/L：22.63 ±9.72 vs.14.95 ±8.39,t=3.446,P=0.001）,blood lactate [Lac （mmol/L）：6.7 （2.2,12.1） vs.1.9 （1.1,3.4）,Z=-3.294,P=0.001] were significantly higher,and the reduction rate of paraquat concentration in urine after first perfusion [（38.4 ± 15.63）％ vs.（67.59 ± 27.87）％,t=2.945,P=0.004] and arterial partial pressure of carbon dioxide [PaCO2 （mmHg,1 mmHg=0.133 kPa）：28.7 ± 9.3 vs.34.8 ± 6.7,t=-3.245,P=0.002] were significantly lowered.There was no significant difference between two groups i

关 键 词：中毒 百草枯 早期死亡 预后 动脉血乳酸 血白细胞计数 

分 类 号：R595.4[医药卫生—内科学]