低钾血症在急性百草枯中毒早期预后评估中的价值  

Clinical value of hypokalemia to predicting the prognosis of acute paraquat poisoning in the early stage

作　　者：刘尊齐[1] 徐甲瑞[1] 陈福迪[1] 王海石[1] 张兴国[1] 刘东兴[1] 商徳亚 郝凤桐[2] 

机构地区：[1]山东大学附属省立医院急救中心,济南250021 [2]北京朝阳医院职业病中毒科,北京100043

出　　处：《中华实用诊断与治疗杂志》2015年第1期50-52,共3页Journal of Chinese Practical Diagnosis and Therapy

基　　金：卫生部卫生行业科研专项项目(201202006-06)

摘　　要：目的探讨急性百草枯中毒早期低钾血症在临床预后评估中的价值。方法 182例百草枯中毒患者根据随访结果分为存活组和死亡组,比较2组患者临床资料,采用二元logistic回归分析影响百草枯中毒死亡的因素;根据入院时血钾浓度分为低钾血症组83例与非低钾血症组99例,比较2组生存率,采用ROC曲线分析血清钾水平评估百草枯中毒患者存活的敏感性和特异性,采用Kaplan-Meier法分析低钾血症与死亡的关系。结果 182例患者中存活70例,死亡112例,病死率为61.53%;死亡组年龄,服毒量,入院时白细胞计数、血红蛋白、血糖、血尿素氮、血肌酐、血清钾、CO2总量、阴离子间隙和尿百草枯浓度与存活组比较差异有统计学意义（P〈0.05）;服毒量（OR=0.057,95%CI：0.916～0.975,P=0.016）、尿百草枯浓度（OR=1.937,95%CI：0.039～0.536,P=0.004）、血清钾（OR=-1.725,95%CI：1.259～24.995,P=0.024）、血肌酐（OR=0.048,95%CI：0.913～0.996,P=0.034）和阴离子间隙（OR=0.225,95%CI：0.654～0.976,P=0.028）是急性百草枯中毒患者死亡的独立预测因素;血清钾为3.45mmol/L时,预测百草枯中毒患者60d存活的敏感性为91.4%,特异性为68.7%;Kaplan-Meier生存分析显示,低钾血症组生存率（7.23%）明显低于非低钾血症组（64.65%）（P〈0.05）,低钾血症是百草枯中毒患者死亡的高危因素（OR=8.943,95%CI：4.082～19.593,P=0.000）。结论百草枯中毒早期低钾血症可能是爆发型百草枯中毒的特征,低钾血症可作为评估患者死亡风险的临床指标。Objective To study the clinical value of hypokalemia to predicting the prognosis of acute paraquat poisoning in the early stage.Methods A total of 182 patients with paraquat poisoning were divided into survival group and death group according to the follow-up results.The clinical data were compared between two groups.The death factors were explored by binary logistic regression analysis.The patients were divided into hypokalemia group（n=83）and nonhypokalemia group（n=99）according to the serum potassium concentrations at admission,and the survival rates were compared between two groups.ROC curve was used to determine the sensitivity and specificity of serum potassium for predicting the survival,and Kaplan-Meier method was used to analyze the relationship between hypokalemia and death.Results In 182 patients,70 survived and 112 died,with the fatality of 61.53%.Significant differences were found between the survival and death groups in the age,the amount of ingested,white blood cell count,hemoglobin,plasma glucose,blood urea nitrogen,creatinine,serum potassium,CO2,anion gap and urine concentrations of paraquat（P〈0.05）,among which the amount of ingested（OR=0.057,95% CI：0.916 to 0.975,P=0.016）,urine concentration of paraquat（OR=1.937,95% CI：0.039 to 0.536,P=0.004）,serum potassium（OR=-1.725,95%CI：1.259to24.995,P=0.024）,creatinene（OR=0.048,95% CI：0.913 to 0.996,P=0.034）and anion gap（OR=0.225,95%CI：0.654 to 0.976,P =0.028）were the independent prognostic factors for death.When serum potassium concentration was 3.45mmol/L,the sensitivity was 91.4%,and specificity was 68.7% for predicting the survival of the patients with paraquat poisoning.Kaplan-Meier survival analysis showed the survival rate of hypokalemia group was significantly lower（7.23%）than that in non-hypokalemia group（64.65%）（P〈0.05）.Hypokalemia was the high risk factor for death（OR=8.943,95% CI：4.082 to 19.593,P=0.000）.Conclusion Hypokalemea might be one of distinguishing characteristics in the earl

关 键 词：中毒 百草枯 低钾血症 预后 

分 类 号：R595.4[医药卫生—内科学]