陳運(yùn)超　　徐明　　唐旭　　龍振鴻　　房雪雪　　符如燊

[關(guān)鍵詞] 急性百草枯中毒;死亡;獨(dú)立危險(xiǎn)因素;預(yù)測(cè)

[中圖分類(lèi)號(hào)] R595.4? ? ? ? ? [文獻(xiàn)標(biāo)識(shí)碼] B? ? ? ? ? [文章編號(hào)] 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(nóng)林業(yè)對(duì)百草枯使用需求的激增及人們社會(huì)、生活、心理等壓力的多重因素作用，PQ中毒的發(fā)病率也逐年顯著上升，現(xiàn)已超過(guò)有機(jī)磷成為急性農(nóng)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(guó)2013年公布了《急性百草枯中毒診治專(zhuān)家共識(shí)》，規(guī)范了PQ中毒的診療策略，但是總體治療效果仍不理想。據(jù)統(tǒng)計(jì)PQ中毒死亡率達(dá)50%～95%，中重度死亡率為85%～95%，暴發(fā)型死亡率達(dá)100%[1-3]。積極探索PQ中毒后不同器官、不同系統(tǒng)的損傷機(jī)制，明確影響預(yù)后的相關(guān)因素，建立行之有效的疾病預(yù)測(cè)機(jī)制，并尋求有效的干預(yù)方案和方法，仍然是PQ中毒救治研究的重點(diǎn)和難點(diǎn)。本研究通過(guò)對(duì)急性PQ中毒患者的臨床資料進(jìn)行回顧性研究，分析PQ中毒患者死亡的獨(dú)立危險(xiǎn)因素，為PQ中毒的急診治療以及預(yù)后評(píng)估提供臨床依據(jù)，現(xiàn)報(bào)道如下。