356例ICU急性中毒患者预后因素分析

Analysis of risk factors impacting the outcomes of 356 patients with acute poisoning in ICU WANG

目的通过分析ICU356例急性中毒患者的临床资料，探讨影响急性中毒患者预后的相关因素，为临床防治急性中毒提供依据。方法收集吉林大学第二医院ICU2005年1月至2009年12月收治的356例资料完整的急性中毒患者的临床资料，按照设计的《急性中毒患者临床观察表》记录相关研究内容，采用U检验、X^2检验等方法，行单因素分析和多因素Logistic回归分析，研究性别、年龄、中毒原因、毒物类型、中毒距就诊时间、中毒距人ICU时间、住院时间、心肺复苏、机械通气、急性生理学及慢性健康状况评分Ⅱ（APACHE Ⅱ平分）与预后的关系。结果356例患者分为存活组（260例）与死亡组（96例），存活组住院时间（5．72±4．37）d、中毒距入ICU时间（17．16±31．22）h、APACHEⅡ评分（10．27±7．77）分，与死亡组住院时间（3．53±5．79）d、中毒距入ICU时间（37．21±67．35）h、APACHE Ⅱ评分（18．78±8．66）分之间，差异具有统计学意义（P〈0．05或P〈0．01）；两组间心肺复苏、机械通气、毒物类型差异具有统计学意义（P〈0．05）；多因素Logistic回归分析结果显示住院时间、APACHEⅡ评分、心肺复苏、机械通气、毒物类型与预后明显相关（P〈0．05）。得到死亡风险模型：Y=-0．817-0．137X1＋0．140X3＋2．133X4＋1．039X5-0．291墨。结论住院时间、APACHE肼分、心肺复苏、机械通气、毒物类型为影响预后的独立危险因素；APACHE Ⅱ平分系统可用于急性中毒患者危重程度及预后的评估。

Objective To explore the risk factors influencing the prognosis of patients with acute poisoning by analysis of clinical data of 356 patients in order to provide the scientific evidence for planning therapeutic strategies in ICU. Methods The clinical data of 356 patients with acute poisoning were collected during the period from January 1, 2005 through December 30, 2009, and the clinical findings from close observation were filled into the tables of specially designed ＂ Clinical observation of acute poisoning patients＂. Some risk factors of 356 cases with complete clinical data were studied by single-factor analysis and Logistic multiple regression, such as gender, age, mode and cause of poisoning, kind of poison agents, time elapsed from poisoning to admission into the hospital, time elapsed from poisoning to admission into ICU, length of hospital stay, cardiopulmonary resuscitation, mechanical ventilation, APACHE Ⅱ score. Results Three hundred fifty-six patients with complete data were divided into survival group （n = 260） and death group （ n = 96）. Univariate analysis showed the length of hospital stay （5.72±4. 37） d, APACHE I1 score （10. 27±7. 77）, time elapsed from poisoning to admission into ICU （17. 16±31.22） h in the survival group, and the length of hospital stay （3. 53±5. 79） d, APACHE Ⅱ score （ 18. 78±8.66）, time elapsed from poisoning to admission into the ICU （37. 21±67.35） h in the death group （P 〈 0. 05 or P 〈 0. 01 ）. The differences in rates of CPR, mechanical ventilation and kind of poison agents between the two groups were statistically significant （ P 〈 0. 05 ）. Multivariate Logistic regression analysis revealed that the length of hospital stay, APACHE Ⅱ score, rates of cardiopulmonary resuscitation, mechanical ventilation-and kind of poison agents were positively correlated with prognosis of patients with acute poisoning （ P 〈 0. 05 ）. Model to predict mortality was established： Y = - 0. 817 - 0. 137X1 ＋ 0. 140X3 ＋ 2. 133X4 ＋ 1.039X5 - 0.291X6. Conclusions Hospital stay, APACHE Ⅱ score, cardiopulmonary resuscitation, mechanical ventilation and kind of poison agents were independent risk factors for predicting prognosis. APACHE Ⅱ score system and Logistic regression analysis can be used to evaluate the severity and prognosis of patients with acute poisoning.