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目的描述急性百草枯(Paraquat,PQ)中毒老年患者的早期生存状况,探讨影响患者早期死亡的影响因素及其预测价值。方法选取2011年1月—2016年7月收治的84例急性PQ中毒老年患者作为研究对象,根据中毒后72 h内的预后分为早期死亡组(n=24)和早期存活组(n=60)。比较两组的临床资料及实验室检查结果,应用Logistic多元回归分析探讨影响患者早期死亡的相关因素,并通过受试者工作特征(receiver operating characteristic,ROC)曲线评价各指标对早期死亡的预测价值,P<0.05为差异有统计学意义。结果 84例患者在中毒后24、48、72 h、2个月内的死亡率分别为7.14%、14.29%、28.57%、61.90%。血液灌流前尿中PQ浓度(OR=2.9 25,9 5%CI为1.450~5.9 00)、急性生理与慢性健康评分(acute physiology and chronic health evaluationⅡ,APACHE-Ⅱ)(OR=2.725,9 5%CI为1.453~5.112)、血乳酸值(lactic acid,Lac)(OR=2.008,9 5%CI为1.129~3.573)、血白细胞计数(white blood cell,WBC)(OR=1.992,95%CI为1.100~3.608)及服毒剂量(OR=1.581,9 5%CI为1.033~2.419)是急性PQ中毒老年患者早期死亡的独立影响因素(均P<0.05)。其ROC曲线下面积分别为0.914、0.890、0.785、0.793、0.717(P<0.05)。结论尿中PQ浓度、APACHEⅡ评分、Lac、WBC及服毒剂量可以用来预测急性PQ中毒老年患者早期预后,并有助于临床上制订有效的早期治疗方案。
Objective To describe the early survival of elderly patients with Paraquat (PQ) poisoning and to explore the influencing factors and predictive value of early death in patients with Paraquat. Methods Eighty-four elderly patients with acute PQ poisoning admitted to our hospital from January 2011 to July 2016 were divided into two groups: early death group (n = 24) and early survival group (n = 60) according to the prognosis within 72 hours after poisoning ). The clinical data and laboratory test results were compared between the two groups. Logistic multiple regression analysis was used to explore the factors influencing the early death in patients. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of each indicator for early death , P <0.05 for the difference was statistically significant. Results The mortality rates of 84 patients at 24, 48, 72 h and 2 months after poisoning were 7.14%, 14.29%, 28.57% and 61.90% respectively. The urinary PQ concentration before hemoperfusion (OR = 2.925,9.5% CI 1.450-5.900), acute physiology and chronic health evaluationⅡ (APACHE-Ⅱ) (OR = 2.725, 95% CI was 1.453-5.112), lactic acid (Lac) (OR = 2.008, 95% CI 1.129-3.573), white blood cell (WBC) (OR = 1.992, 95% CI 1.100 ~ 3.608) and the dose of poisoning (OR = 1.581, 95% CI 1.033 ~ 2.419) were the independent influencing factors of early death in elderly patients with acute PQ poisoning (all P <0.05). The area under the ROC curve was 0.914, 0.890, 0.785, 0.793, 0.717 respectively (P <0.05). Conclusion The urinary PQ concentration, APACHEⅡscore, Lac, WBC and drug dose can be used to predict the early prognosis of elderly patients with acute PQ poisoning, and help to develop effective early treatment programs.