柯道++姚为学++周宁++苏耿

[摘要]目的 探討影响百草枯中毒患者预后的相关风险因素，为临床及时评估临床结局和救治提供依据。方法 选取2014年5月～2016年6月我院急救中心收治的86例急性百草枯中毒患者，其中死亡组52例，存活组34例。分析服药剂量、洗胃时间、首次血液灌流时间、APACHEⅡ评分、白细胞计数（WBC）、血肌酐（SCr）、尿素氮（BUN）、丙氨酸氨基转移酶（ALT）、肌酸激酶同工酶（CK-MB）与患者预后的关系，采用多元逐步Logistic 回归分析确定影响患者预后的相关风险因素，并通过ROC曲线评价风险因素对评价患者预后的价值。结果 两组的服药剂量、洗胃时间及WBC计数、SCr、BUN、ALT、CK-MB水平比较，差异有统计学意义（P<0.05）；Logistic回归分析显示，服药剂量和APACHEⅡ评分对患者预后的评估影响较大；APACHEⅡ评分越高，死亡率越高；不同时间点的APACHEⅡ评分对患者死亡评估具有显著性差异（P<0.05）；服药剂量、APACHEⅡ评分及两者联合评价的曲线下面积分别为93.4%、94.5%、96.7%。结论 服药剂量、APACHEⅡ评分可作为评估百草枯中毒患者预后及疾病严重程度的指标，两者联合对评估预后意义更大。

[关键词]百草枯；中毒；预后；风险因素；APACHEⅡ评分

[中图分类号] R595.4 [文献标识码] A [文章编号] 1674-4721（2017）04（c）-0029-04

[Abstract]Objective To investigate the associated risk factors affecting the prognosis of patients with paraquat poisoning，and to provide the basis for clinical timely assess the clinical outcome and treatment.Methods 86 cases of acute paraquat poisoning were selected in emergency department of our hospital from May 2014 to June 2016.52 cases of the death group，34 cases of the survival group.The relationship of medication dosage，the time from the gastric lavage to poisoning，time of the first blood perfusion，APACHEⅡ score，white blood cell count （WBC），serum creatinine （SCr），blood urea nitrogen （BUN），alanine aminotransferase （ALT），creating kinase isoenzyme （CK-MB） with the prognosis of patients were analyzed，the multivariate stepwise Logistic regression analysis was adopted to define the associated risk factors affecting the prognosis of patients with paraquat poisoning，and ROC curve was used to evaluate the value of risk factors in the prognosis of patients.Results There was significant difference in the medication dosage，time of gastric lavage，WBC count and the level of SCr，BUN，ALT，CK-MB between the two groups（P<0.05）.Logistic regression analysis showed that the dosage of medication and APACHE Ⅱ score had a greater impact on the prognosis of patients，the higher of APACHEⅡ score，the higher the mortality rate.APACHEⅡ score at different time points had significant difference in the mortality assessment of patients（P<0.05）.The area under the curve with the dose of medication，APACHEⅡ score and the joint evaluation was 93.4%，94.5% and 96.7%，respectively.Conclusion The dose of medication，APACHEⅡ score can be used as evaluation index of the prognosis of patients with paraquat poisoning and disease severity，the combination of the two indexes is more significant for evaluating prognosis.

[Key words]Paraquat；Poisoning；Prognosis；Risk factor；APACHEⅡ score

百草枯属于联吡啶类的一种接触性除草剂，又称为对草快或克芜踪，由于其除草效果良好，且消失较快，土地残留量及残留毒性较小，因此在我国农业除草中广泛使用[1]。其对人或畜具有极强的毒性，中毒后治疗效果不佳，病死率較高，国内报道病死率高达60.6%～80.3%[2]，国外报道死亡率达73.4%～87.8%[3]。尤为重要的是，目前对百草枯中毒的机制并未阐明，因此也无较好的临床治疗方案，现阶段主要以综合治疗为主，治疗费用较高，治疗效果不甚满意[4]。百草枯中毒患者多来自农村欠发达地区，经济条件有限，进一步增加了患者死亡率，因此，能及时准确判断百草枯中毒患者预后对患者结局及治疗方案的选择具有重要意义。本研究通过对我院收治的急性百草枯中毒患者的临床资料及实验室指标进行回顾性分析及总结，探讨影响百草枯中毒患者预后的因素，为临床治疗及评价患者预后提供参考依据，现报道如下。……