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目的:探讨早期判断百草枯(PQ)中毒患者预后的临床指标。方法:纳入2009年6月—2010年12月全军中毒救治中心收治的154例急性口服百草枯中毒患者(均为24 h内入院),分析生化指标(包括肝、肾功能,动脉血氧分压等)与患者预后相关性。结果:154例百草枯中毒患者中,病死72例,病死率46.8%,患者生存时间6.8±4.7(2~24)天。其中7天内病死45例,占总病死例数的62.5%,其原因多为脏器功能衰竭,7天后病死27例,占总病死例数的37.5%,其原因均为低氧血症。存活组与病死组3天内有无肝损伤的病死率差异显著(P<0.01),而第4天至第7天内有无肝损伤的病死率无显著差异(P>0.05)。3天内有无肾损伤的病死率差异显著(P<0.01),第4天至第7天内有无肾损伤的病死率无显著差异(P>0.05)。存活组与病死组在血尿毒检、服毒量、肝肾损伤发生时间、肝肾损伤发生率、肝肾峰值及低氧血症发生时间差异显著(P<0.05),而在就诊时间、入院时肝肾值、入院时氧分压及低氧血症最低值无显著差异。多重Logistic回归分析发现,血毒检、肝损伤、低氧血症是病死危险因素,而肾损伤却不是患者病死的危险因素。ROC曲线显示肝损伤时ALT值对百草枯预后有判断意义。结论:百草枯中毒患者中的生化指标,尤其是肝功能对早期判断患者预后有临床指导意义。
Objective: To explore the early prognosis of paraquat (PQ) poisoning in patients with clinical indicators. Methods: A total of 154 acute paraquat poisoning patients admitted to the PLA from June 2009 to December 2010 were enrolled within 24 h. Biochemical parameters (including liver and renal function, arterial oxygenation Pressure, etc.) and patient prognosis. Results: Among 154 paraquat poisoning patients, 72 died and the case fatality rate was 46.8%. The patients’ survival time was 6.8 ± 4.7 days (2 ~ 24 days). Among them, 45 died within 7 days, accounting for 62.5% of the total number of deaths. The reasons were mostly organ failure, 27 died after 7 days, accounting for 37.5% of the total number of deaths. The reasons were hypoxemia. There was significant difference (P <0.01) in the case fatality rate between the surviving group and the deceased group within 3 days, while there was no significant difference between the 4th day and the 7th day in the case fatality rate without liver injury (P> 0.05). There was significant difference (P <0.01) in the case fatality rate with or without renal injury within 3 days, and there was no significant difference in the case fatality rate with or without renal injury between the 4th day and the 7th day (P> 0.05). There was significant difference between the survival group and the dead group in the time of diagnosis, the dose of poisoning, the time of liver and kidney injury, the incidence of liver and kidney injury, the peak of liver and kidney and the time of hypoxemia (P <0.05) Liver and kidney values, admission oxygen partial pressure and hypoxemia no significant difference. Multiple Logistic regression analysis found that blood poisoning, liver injury, hypoxemia are the risk factors for death, but kidney damage is not a risk factor for death in patients. The ROC curve shows that the ALT value in liver injury is of significance for the prognosis of paraquat. Conclusion: The biochemical indexes in patients with paraquat poisoning, especially liver function, have clinical significance in early prognosis of patients.