影响百草枯中毒患者预后的相关风险因素分析  

Analysis of the risk factors of affecting the prognosis of the paraquat poisoning patients

作　　者：柯道[1] 姚为学[1] 周宁[1] 苏耿[1] 

机构地区：[1]广东省湛江中心人民医院急救中心,广东湛江524037

出　　处：《中国当代医药》2017年第12期29-31,46,共4页China Modern Medicine

摘　　要：目的探讨影响百草枯中毒患者预后的相关风险因素,为临床及时评估临床结局和救治提供依据。方法选取2014年5月~2016年6月我院急救中心收治的86例急性百草枯中毒患者,其中死亡组52例,存活组34例。分析服药剂量、洗胃时间、首次血液灌流时间、APACHEⅡ评分、白细胞计数(WBC)、血肌酐(SCr)、尿素氮(BUN)、丙氨酸氨基转移酶(ALT)、肌酸激酶同工酶(CK-MB)与患者预后的关系,采用多元逐步Logistic回归分析确定影响患者预后的相关风险因素,并通过ROC曲线评价风险因素对评价患者预后的价值。结果两组的服药剂量、洗胃时间及WBC计数、SCr、BUN、ALT、CK-MB水平比较,差异有统计学意义(P<0.05);Logistic回归分析显示,服药剂量和APACHEⅡ评分对患者预后的评估影响较大;APACHEⅡ评分越高,死亡率越高;不同时间点的APACHEⅡ评分对患者死亡评估具有显著性差异(P<0.05);服药剂量、APACHEⅡ评分及两者联合评价的曲线下面积分别为93.4%、94.5%、96.7%。结论服药剂量、APACHEⅡ评分可作为评估百草枯中毒患者预后及疾病严重程度的指标,两者联合对评估预后意义更大。Objective To investigate the associated risk factors affecting the prognosis of patients with paraquat poisoning,and to provide the basis for clinical timely assess the clinical outcome and treatment.Methods 86 cases of acute paraquat poisoning were selected in emergency department of our hospital from May 2014 to June 2016.52 cases of the death group,34 cases of the survival group.The relationship of medication dosage,the time from the gastric lavage to poisoning,time of the first blood perfusion,APACHE Ⅱ score,white blood cell count （WBC）,serum creatinine （SCr）,blood urea nitrogen （BUN）,alanine aminotransferase （ALT）,creating kinase isoenzyme （CK-MB） with the prognosis of patients were analyzed,the multivariate stepwise Logistic regression analysis was adopted to define the associated risk factors affecting the prognosis of patients with paraquat poisoning,and ROC curve was used to evaluate the value of risk factors in the prognosis of patients.Results There was significant difference in the medication dosage,time of gastric lavage, WBC count and the level of SCr,BUN,ALT,CK-MB between the two groups（P〈0.05）.Logistic regression analysis showed that the dosage of medication and APACHE Ⅱ score had a greater impact on the prognosis of patients,the higher of APACHE Ⅱ score,the higher the mortality rate.APACHE Ⅱ score at different time points had significant difference in the mortality assessment of patients （P〈0.05）.The area under the curve with the dose of medication,APACHE Ⅱ score and the joint evaluation was 93.4%,94.5% and 96.7%,respectively.Conclusion The dose of medication,APACHE Ⅱ score can be used as evaluation index of the prognosis of patients with paraquat poisoning and disease severity,the combination of the two indexes is more significant for evaluating prognosis.

关 键 词：百草枯 中毒 预后 风险因素 APACHEⅡ评分 

分 类 号：R595.4[医药卫生—内科学]