急性百草枯中毒死亡危险因素的预测分析  

Predictive analysis of the risk factors of death from acute paraquat poisoning

作　　者：陈运超[1] 徐明[1] 唐旭[1] 龙振鸿 房雪雪 符如燊 CHEN Yunchao;XU Ming;TANG Xu;LONG Zhenhong;FANG Xuexue;FU Rushen(Department of Critical Care Medicine,Guangzhou Twelfth People's Hospital,Guangzhou 510620,China)

机构地区：[1]广州市第十二人民医院重症医学科,广东广州510620

出　　处：《中国现代医生》2021年第21期81-85,F0003,共6页China Modern Doctor

基　　金：广东省医学科研基金项目(A2017268)。

摘　　要：目的分析急性百草枯(Paraquat,PQ)中毒患者的死亡独立危险因素,为PQ中毒的急诊治疗及预后评估提供临床依据。方法回顾性分析2016年1月至2019年12月期间我院收治的、年龄>12岁、中毒时间<24 h的PQ中毒患者的95例临床资料。按照1个月后的结局分为死亡组53例和存活组42例;对比两组患者入院时的基本情况、检验指标、血液净化治疗等临床资料;应用Logistic回归分析PQ中毒死亡的独立危险因素,并绘制受试者工作特征曲线,评价各危险因素对预后评估的准确性。结果服毒量、启动血液净化时间、血乳酸为PQ中毒患者死亡的独立危险因素;服毒量>58.5 mL、启动血液净化时间>5.5 h、血乳酸>5.95 mmol/L的PQ中毒患者死亡风险明显升高;对PQ的死亡预测能力从高至低依次为:血乳酸、启动血液净化时间、服毒量。结论在临床工作中必须尽早对PQ中毒患者实施血液净化治疗,迅速、有效降低体内的PQ浓度,有助于提高PQ中毒患者的存活率;同时结合服毒量及血乳酸水平可作为预测PQ中毒患者死亡的可靠性指标。Objective To analyze independent risk factors for death in patients with acute paraquat(PQ)poisoning,and to provide clinical evidence for emergency treatment and prognosis evaluation of PQ poisoning.Methods The clinical data of 95 patients with PQ poisoning admitted to our hospital from January,2016 to December,2019,who were older than 12 years old and had been poisoned for less than 24 hours were retrospectively analyzed.According to the outcome after one month,they were divided into 53 cases in the death group and 42 cases in the survival group.The basic conditions,test indicators,and blood purification treatment of the two groups at the time of admission were compared.Logistic regression was used to analyze the independent risk factors of death from PQ poisoning.And the receiver operating characteristic curve was drawn.The accuracy of the prognostic evaluation of each risk factor was evaluated.Results The dose of poison,the time to start blood purification,and blood lactic acid were independent risk factors for death in PQ poisoned patients.The risk of death was significantly increased in PQ poisoned patients with the dose of poison more than 58.5 mL,the time to start blood purification more than 5.5 h,and the blood lactic acid more than 5.95 mmol/L.The predictive ability of PQ's death from high to low was blood lactic acid,time to start blood purification,and dose of poison.Conclusion In clinical work,it is necessary to implement blood purification treatment for patients with PQ poisoning as soon as possible to quickly and effectively reduce the PQ concentration in the body,which will help to improve the survival rate of patients with PQ poisoning.At the same time,combining the dose and blood lactic acid level can be used as a reliable predictor of death in patients with PQ poisoning.

关 键 词：急性百草枯中毒 死亡 独立危险因素 预测 

分 类 号：R595.4[医药卫生—内科学]