急性百草枯中毒死亡危險因素的預測分析

陳運超　　徐明　　唐旭　　龍振鴻　　房雪雪　　符如燊

[關鍵詞] 急性百草枯中毒;死亡;獨立危險因素;預測

[中圖分類號] R595.4? ? ? ? ? [文獻標識碼] B? ? ? ? ? [文章編號] 1673-9701（2021）21-0081-05

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

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

[Abstract] 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.

[Key words] Acute paraquat poisoning; Death; Independent risk factors; Prediction

隨著農林業對百草枯使用需求的激增及人們社會、生活、心理等壓力的多重因素作用，PQ中毒的發病率也逐年顯著上升，現已超過有機磷成為急性農藥中毒的首位[1]。PQ毒性極高，20%水溶液5～15 mL或原液40 mg/kg左右即可致人死亡。雖然我國2013年公布了《急性百草枯中毒診治專家共識》，規范了PQ中毒的診療策略，但是總體治療效果仍不理想。據統計PQ中毒死亡率達50%～95%，中重度死亡率為85%～95%，暴發型死亡率達100%[1-3]。積極探索PQ中毒后不同器官、不同系統的損傷機制，明確影響預后的相關因素，建立行之有效的疾病預測機制，并尋求有效的干預方案和方法，仍然是PQ中毒救治研究的重點和難點。本研究通過對急性PQ中毒患者的臨床資料進行回顧性研究，分析PQ中毒患者死亡的獨立危險因素，為PQ中毒的急診治療以及預后評估提供臨床依據，現報道如下。