急性百草枯中毒导致多器官损伤的临床观察  

Clinical study of multiple organ damage caused by acute paraquat poisoning

作　　者：高艳霞[1] 王艺博 李毅[2] 江亚南[3] 侯林林 张岩[1] 孙沛 孙昌华[1] 段国宇[1] 徐志高[1] 车璐[1] 李素娟[1] 闫改勤 余言午 袁丁[1] Gao Yanxia;Wang Yibo;Li Yi;Jiang Yanan;Hou Linlin;Zhang Yan;Sun Pei;Sun Changhua;Duan Guoyu;Xu Zhigao;Che Lu;Li Sujuan;Yan Gaiqin;Yu Yanwu;Yuan Ding(Emergency Department,Zhengzhou University First Affiliated Hospital,Zhengzhou 450052,China;Emergency Department,Chinese Academy of Medical Sciences,Peking Union Medical College Hospital,100730,China;Department of Pathophysiology,School of Basic Medical Sciences,Zhengzhou University,Zhengzhou 450001,China)

机构地区：[1]郑州大学第一附属医院郑东院区急救中心,450052 [2]北京协和医院急诊科,100730 [3]郑州大学基础医学院病理生理教研室,450051

出　　处：《中华急诊医学杂志》2020年第11期1411-1416,共6页Chinese Journal of Emergency Medicine

基　　金：国家自然科学基金青年基金项目(81701893);国家科技重大专项(2017ZX10103005-009);河南省医学科技攻关计划省部共建项目(SB201901006);河南省高等学校重点科研项目(20A320046)。

摘　　要：目的通过观察急性百草枯(paraquat,PQ)中毒患者不同时间点各脏器的标志物水平,分析各脏器受损的发生率和先后顺序。方法纳入2013年7月至2014年8月收治于郑州大学第一附属医院的急性PQ患者进行回顾性分析,根据患者生存情况分为生存组和死亡组,记录患者中毒后第1、3、5、7天的胰腺功能、肝功能、肾功能、心肌酶、血气分析等指标及相关临床资料,分析主要脏器损伤的发生率、出现损伤的时间、先后顺序以及各脏器损伤标志物的动态变化。两组间各脏器损伤发生率比较采用卡方检验,生存组与死亡组各指标随时间动态变化的比较采用重复测量的方差分析。结果共纳入177例急性PQ中毒患者,其中生存组110例,死亡组67例,两组患者性别差异无统计学意义,年龄与服毒量间差异有统计学意义(P<0.05);总体各脏器损伤发生率:消化道(99.4%)、胰腺(43.5%)、肺(38.4%)、肝(35.6%)、肾(29.4%)、心脏(20.3%);初发时间:胰腺(2.2±1.8)d、消化道(2.9±0.4)d、肝(3.4±2.1)d、心脏(5.3±1.3)d、肾脏(6.1±2.3)d、肺(6.9±1.4)d。与生存组相比,死亡组各脏器功能受损发生率更高,肺(98.5%vs 1.8%)、胰腺(88.1%vs 16.4%)、肝脏(65.7%vs 17.2%)、肾脏(50.7%vs 16.4%)、心脏(40.3%vs 8.2%);死亡组在各个时间点的胰腺功能、肝功能、肾功能、心肌酶、血气分析、白细胞计数等指标较生存组更为异常,差异有统计学意义(P<0.05);随时间推移,死亡组白细胞计数、淋巴细胞百分比、中性粒细胞百分比、肌酸激酶同工酶、谷丙转氨酶水平无明显波动,其余各项指标均有加重趋势;而生存组各项指标略有改善或变化不明显。结论急性PQ中毒后脏器损伤发生率由高到低依次为消化道、胰腺、肺、肝、肾、心脏,损伤初发时间由早到晚依次为胰腺、消化道、肝、心、肾、肺;相较于生存组,死亡组器官受损发生率更高,损伤程度更严重,且呈逐渐�Objective In order to find new ideas for the treatment of acute paraquat poisoning,the levels of biomarkers in different organs of patients with acute paraquat poisoning were observed and the incidence and sequence of organ damage were analyzed.Methods Patients with acute paraquat poisoning who were admitted to the Emergency Department of the First Affiliated Hospital of Zhengzhou University from July 2013 to August 2014 were retrospectively analyzed.Patients were divided into the survival and death groups according to the outcome.The pancreatic function,liver function,renal function,myocardial enzyme,blood gas analysis and related clinical data were recorded on the 1st,3rd,5th and 7th day after poisoning,the incidence of major organ damage,the time and sequence of damage,and the dynamic changes of markers of organ damage were analyzed.Chi-square test was used for the incidence of organ damage between the two groups,and the dynamic changes of indexes in the survival group and death group with time were analyzed by repeated measurement ANOVA.Results In this study,177 patients with acute paraquat poisoning were included,including 110 patients in the survival group and 67 patients in the death group.There was no difference in gender between the two groups,but significant differences in the age and the amount of drug taken(P<0.05).The overall incidence of organ damage was as follows:digestive tract(99.4%),pancreas(43.5%),lung(38.4%),liver(35.6%),kidney(29.4%),and heart(20.3%);the average initial time was as follows:pancreas(2.2±1.8)d,digestive tract(2.9±0.4)d,liver(3.4±2.1)d,heart(5.3±1.3)d,kidney(6.1±2.3)d,and lung(6.9±1.4)d.Compared with the survival group,the death group had a higher incidence of impaired organ function(lung,98.5%vs 1.8%;pancreas,88.1%vs 16.4%;liver,65.7%vs 17.2%;kidney,50.7%vs 16.4%;and heart,40.3%vs 8.2%).The pancreatic function,liver function,renal function,myocardial enzyme,blood gas analysis,white blood cell count and other indicators in the death group were more abnormal than those in

关 键 词：急性百草枯中毒 多脏器损伤 脏器损伤规律 

分 类 号：R595.4[医药卫生—内科学]