急性砷化氢中毒的预后因素分析

Study of Prognosis Index in Patients with Acute Arsenic Trihydride Poisoning

目的评估急性砷化氢中毒患者的临床预后,指导早期干预和治疗。方法回顾性分析2010年7月-2014年1月收治的20例急性砷化氢中毒患者的临床资料,通过单因素分析,比较死亡和存活患者中毒至首次救治的时间,尿砷浓度、血常规和肝肾功能检查、电解质、心肌酶及动脉血气分析等指标的差异性。并根据单因素分析结果,将上述有阳性意义的指标进行logistic回归分析,探寻可能影响患者生存的影响因素。结果死亡组患者中毒至救治的时间、尿砷浓度、血清总胆红素、肌酐、肌酸激酶明显高于存活组,而pH值、HCO3-、碱乘余值均低于存活组,差异有统计学意义(P<0.05)。logistic回归分析显示,上述指标对生存有显著影响。结论急性砷化氢中毒后救治时间窗,心、肝、肾等脏器受损和酸碱失衡的程度与患者的生存预后密切相关,及早地掌控上述情况,并根据结果积极开展救治,有助于改善患者的预后。

Objective To observe the prognosis index in acute arsenic trihydride poisoning patients in order to provide references for early clinical treatment. Methods We retrospectively analyzed the clinical data of 20 acute arsenic trihydride poisoning patients treated between July 2010 and January 2014. The patients were divided into death group and survival group according to survival situation 90 days later. The length of time from onset to treatment, urine arsenic concentration, blood routine, hepatic and renal function, electrolyte, myocardial enzyme, arterial blood gas analysis were observed by single factor analysis, and the positive indexes were analyzed by logistic regression analysis to seek the potential influencing factors for survival. Results Compared with the survival group, the length of time from onset to treatment, urine arsenic, serum total bilirubin, creatinine, ereatine kinase of the death group were significantly higher （P 〈 0.05）, while the value of pH, HCO-3, BE of the survival group were significantly lower （P 〈 0.05）. Logistic regression analysis revealed that these indexes remarkably affected patients＇ survival rate. Conclusion Therapeutic time window, extent of damage of heart, liver, kidney and acid-base imbalance are closely associated with the survival rate of arsenic trihydride poisoning patients, and timely treatment for above factors can be useful for improving prognosis.