急性百草枯中毒患者血流动力学特点与预后的相关性分析  

Analysis of correlation between hemodynamic characteristics and prognosis in patients with acute paraquat poisoning

作　　者：许小云[1] 徐明[2] 李小强[2] 陈运超[2] XU Xiaoyun;XU Ming;LI Xiaoqiang(Department of Critical Care Medicine, Guangzhou No.12 People's Hospital,Guangzhou,510620,China;Department of Physical Examination Center, Guangzhou No.12 People’s Hospital,Guangzhou,510620,China)

机构地区：[1]广东省广州市第十二人民医院体检中心,广州510620 [2]广东省广州市第十二人民医院重症医学科,广州510620

出　　处：《江西医药》2019年第4期304-308,共5页Jiangxi Medical Journal

基　　金：广东省医学科研基金,编号A2017268

摘　　要：目的收集急性百草枯(paraquat,PQ)中毒患者的血流动力学指标,分析不同临床分型、不同预后结局的患者急性期血流动力学变化趋势及特点,探讨其与预后的相关性,为临床循环支持治疗策略的制定提供参考。方法采用回顾性病例观察研究,以2016年7月至2018年7月于广州市第十二人民医院收治的PQ中毒患者为研究对象,全面收集其人口学信息、百草枯浓度、中毒时间、血流动力学指标、预后等相关数据,分析百草枯毒物浓度、中毒时间对血流动力学指标的影响,以及血流动力学参数与预后的相关性。结果存活组与死亡组在不同时间点的收缩压、舒张压、平均动脉压等比较,差异均有统计学意义(P<0.05)。每搏输出量组间比较,除0h差异无统计学意义外,其他3个时间点差异均有统计学意义(P<0.05);心输出量组间比较,仅48h时间点组间差异有统计学意义;提示尽管经过治疗,难以改善的心输出量可能与死亡相关。另外,血乳酸水平作为评价微循环障碍的重要指标之一,在PQ中毒48h内的不同时间点,存活组与死亡组之间亦存在差异(P<0.05),表明相对于存活组而言,死亡组可能存在着更难纠正的微循环障碍。血流动力学参数与PQ中毒预后的相关性分析表明:初始血乳酸浓度、24h及48h心输出量、24h及48h平均动脉压是影响预后的危险因素。对于时间小于8h的PQ中毒患者,初始血乳酸浓度是影响预后的独立危险因素。对于中毒时间在8~48h的PQ中毒患者8h及24h血乳酸浓度是影响预后的独立危险因素。结论排除时间及中毒剂量因素,血流动力学参数中24h及48h心输出量、24h及48h平均动脉压是影响预后的危险因素。因此,对于中毒时间、中毒剂量不明的PQ中毒患者,动态监测血流动力学参数对于预后评估十分重要。另外,对就诊时中毒时间不同的患者,不同时间点的动脉血乳酸水平对预后判断的价值不�Objective To collect hemodynamic parameters of patients with acute paraquat(PQ) poisoning,analyze the trend and characteristics of hemodynamic changes in patients with different clinical types and different prognosis outcomes in acute phase,and explore its correlation with prognosis,so as to provide reference for the formulation of clinical circulatory support treatment strategies. Methods A retrospective case study was conducted to collect demographic information,paraquat concentration,poisoning time,hemodynamic parameters and prognosis of patients with PQ poisoning admitted to Guangzhou Twelfth People’s Hospital from July 2016 to July 2018. The effects of paraquat concentration,poisoning time on hemodynamic parameters and blood flow were analyzed. The correlation between hydrodynamic parameters and prognosis. Results There were significant differences in systolic blood pressure,diastolic blood pressure and mean arterial pressure between survival group and death group at different time points(P<0.05). There was no significant difference in stroke output between groups except 0 h(P<0.05). There was significant difference in cardiac output between groups at 48 h(P<0.05). It suggested that the cardiac output which was difficult to improve after treatment might be related to death. In addition,blood lactate level is one of the important indicators for evaluating microcirculatory disturbance. At different time points within 48 hours of PQ poisoning,there are also differences between the survival group and the death group(P<0.05),indicating that the death group may have more difficult to correct microcirculatory disturbance than the survival group. The correlation analysis between hemodynamic parameters and prognosis of PQ poisoning showed that initial blood lactate concentration,cardiac output at 24 h and 48 h,mean arterial pressure at 24 h and 48 h were risk factors for prognosis.Initial blood lactate concentration was an independent risk factor for prognosis in patients with poisoning of PQ less than 8 hours.For

关 键 词：百草枯中毒 血流动力学 乳酸 预后 相关性 

分 类 号：R595.4[医药卫生—内科学]