急性百草枯中毒早期死亡35例原因分析

Clinical Study on Early Death Reasons in Patients with Acute Paraquat Poisoning

目的探讨急性百草枯中毒患者早期(5天内)死亡原因及预后影响因素。方法对58例急性百草枯中毒患者中毒时间、中毒剂量、动态血气分析以及胸部影像学作回顾性分析。结果百草枯中毒患者58例早期死亡35例,早期死亡率为60%,非早期死亡病例23例占40%。早期死亡组患者中毒剂量大,入院时血乳酸水平明显升高,碱剩余明显下降,具有显著性差异(P<0.01);早期死亡组与非早期死亡组Pa O2、Pa CO2、氧合指数、p H结果及胸部影像学变化无差异(P>0.05)。结论服毒剂量大导致组织缺氧所致的严重乳酸酸中毒和代谢酸中毒,使心肌收缩无力导致循环衰竭是急性百草枯中毒患者早期死亡的主要原因,乳酸和碱剩余水平可作为评判患者预后的指标。

Objective To study the acute paraquat poisoning patients in the early period（5 days） cause of death and prognostic factors. Methods On 58 cases of acute paraquat poisoning patients clinical materials（poisoning time,poisoning doses, dynamic blood gas analysis and chest imaging） were retrospectively analyzed. Results 58 cases of early death in 35 cases,mortality is 60%, of nor early death in 23 cases（40%）. Early death group of patients poisoning doses than nor early death was bigger; early death group of patients at admission blood lactate and buffer excess than nor early death was significantly elevated and obviously lowly, the difference has statistical significance（P〈0.01）.Group of early death and nor early death Pa O2, Pa CO2, oxygenation index, PH and chest radiographic changes without difference（P〈0.05）. Conclusions Poisoning doses large caused hypoxia that induced lactic acidosis and metabolic acidosis, myocardial contraction asthenia causing the circulatory failure is acute paraquat poisoning patients during the early phase of the main causes of death. Blood lactate and buffer excess can be a prognostic index on acute paraquat poisoning patients.