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目的:探讨急性百草枯中毒(APP)患者早期经验性使用抗生素的影响因素,为合理使用抗生素提供参考。方法:回顾性收集我院急诊科2010-09-2015-12收治的已在院外经验性使用抗生素、入院后完成百草枯(PQ)血浆浓度测定且48h内完成肺部影像学检查的APP患者资料,以《中国成人社区获得性肺炎诊断和治疗指南(2016版)》作为肺部感染诊断标准将其分为感染组和非感染组,对2组患者资料进行统计学分析比较。以是否合并肺部感染为终点指标进行Logistic回归分析。结果:122例患者中男43例、女79例,年龄(31.30±13.83)岁,2组患者的性别、年龄、是否洗胃、PQ中毒严重程度指数(SIPP)、中毒至就诊时间、体温、中性分叶核粒细胞百分率和降钙素原(PCT)差异无统计学意义,白细胞(WBC)计数、呼吸系统症状或体征差异有统计学意义。Logistic回归结果提示中毒至就诊时间、WBC计数、呼吸系统症状或体征这3项指标对是否合并感染有统计学意义。结论:中毒至就诊时间、WBC计数和呼吸系统症状体征可作为早期判断APP患者是否合并肺部感染的影响因素;对于在较短中毒时间窗内出现WBC计数升高和肺炎相关的呼吸系统症状体征的APP患者,可考虑早期经验性使用抗生素。
Objective: To investigate the influencing factors of early empirical antibiotic use in patients with acute paraquat poisoning (APP), and to provide a reference for the rational use of antibiotics. Methods: The retrospectively collected data of patients with APP who completed the pulmonary imaging examination within 48 hours after completion of the paraquat (PQ) plasma concentration after hospital admission in the emergency department of our hospital from 2010-09-2015-12, The data were divided into two groups according to “Guide to Diagnosis and Treatment of Acquired Pneumonia in Chinese Adults (2016 Edition)” as the diagnostic criteria of pulmonary infection. The data of two groups were statistically analyzed and compared. Logistic regression analysis was performed on whether or not pulmonary infection was combined. Results: There were 43 males and 79 females in the 122 cases, with a mean age of (31.30 ± 13.83) years. The gender, age, gastric lavage, PQ Poisoning Index (SIPP), time to treatment, body temperature, Neutrophil granulocyte percentage and procalcitonin (PCT) difference was not statistically significant, white blood cell (WBC) count, respiratory symptoms or signs of significant differences. The results of Logistic regression indicated that the three indexes of poisoning till the time of visiting, WBC count, respiratory symptoms or signs were statistically significant to the co-infection. CONCLUSIONS: The timing of admission to treatment, WBC count, and signs of respiratory symptoms can be used as early predictors of pulmonary infection in patients with APP. For patients with elevated WBC counts and pneumonia-related respiratory symptoms and signs in short poisoning time windows Of APP patients, consider the early empirical use of antibiotics.