急性百草枯中毒死亡危险因素的预测分析

陈运超　　徐明　　唐旭　　龙振鸿　　房雪雪　　符如燊

[关键词] 急性百草枯中毒;死亡;独立危险因素;预测

[中图分类号] R595.4          [文献标识码] B          [文章编号] 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

隨着农林业对百草枯使用需求的激增及人们社会、生活、心理等压力的多重因素作用，PQ中毒的发病率也逐年显著上升，现已超过有机磷成为急性农药中毒的首位[1]。PQ毒性极高，20%水溶液5～15 mL或原液40 mg/kg左右即可致人死亡。虽然我国2013年公布了《急性百草枯中毒诊治专家共识》，规范了PQ中毒的诊疗策略，但是总体治疗效果仍不理想。据统计PQ中毒死亡率达50%～95%，中重度死亡率为85%～95%，暴发型死亡率达100%[1-3]。积极探索PQ中毒后不同器官、不同系统的损伤机制，明确影响预后的相关因素，建立行之有效的疾病预测机制，并寻求有效的干预方案和方法，仍然是PQ中毒救治研究的重点和难点。本研究通过对急性PQ中毒患者的临床资料进行回顾性研究，分析PQ中毒患者死亡的独立危险因素，为PQ中毒的急诊治疗以及预后评估提供临床依据，现报道如下。