急性百草枯中毒患者早期经验性应用抗生素因素分析

Retrospective analysis of the related factors of early empirical antimicrobial therapy in acute paraquat poisoning patients

目的:探讨急性百草枯中毒(APP)患者早期经验性使用抗生素的影响因素,为合理使用抗生素提供参考。方法:回顾性收集我院急诊科2010-09-2015-12收治的已在院外经验性使用抗生素、入院后完成百草枯(PQ)血浆浓度测定且48h内完成肺部影像学检查的APP患者资料,以《中国成人社区获得性肺炎诊断和治疗指南(2016版)》作为肺部感染诊断标准将其分为感染组和非感染组,对2组患者资料进行统计学分析比较。以是否合并肺部感染为终点指标进行Logistic回归分析。结果:122例患者中男43例、女79例,年龄(31.30±13.83)岁,2组患者的性别、年龄、是否洗胃、PQ中毒严重程度指数(SIPP)、中毒至就诊时间、体温、中性分叶核粒细胞百分率和降钙素原(PCT)差异无统计学意义,白细胞(WBC)计数、呼吸系统症状或体征差异有统计学意义。Logistic回归结果提示中毒至就诊时间、WBC计数、呼吸系统症状或体征这3项指标对是否合并感染有统计学意义。结论:中毒至就诊时间、WBC计数和呼吸系统症状体征可作为早期判断APP患者是否合并肺部感染的影响因素;对于在较短中毒时间窗内出现WBC计数升高和肺炎相关的呼吸系统症状体征的APP患者,可考虑早期经验性使用抗生素。

Objective：To explore the related factors of early empirical antimicrobial therapy in acute paraquat poisoning （APP） patients. Method：Cases of APP from West China Hospital emergency department during September 2010 to Novemember 2015 were retrospected. Patients in these cases were treated with antimicrobial in other hospitals before admission, plasma concentrations of paraquat （PQ） were tested soon after admission,and imageo-logical examinations which include X-ray and CT scan were done within 48 hours after admission. The patients were divided into infectious group and non-infectious group according to Guidelines for diagnosis and treatment of adult community-acquired pneumonia （2016 version）,and then statistical analysis was made on the basis of datas collected. Result： There were 122 cases with male （43 cases, 35, 25%）/female （79 cases, 64.75 %）, age 31.30±13.83 years old. Gender,age,gastric lavage or not,severity index of paraquat poisoning（SIPP）,Time from poison- ing to admission（TPA）, body temperature,neutrophilic segmented granulocyte percentage （N%） and procalcitonin （PCT） had no significant difference. White blood cell （WBC） count and respiratory system related clinical manifes-tation （RSCM） had significant difference among two groups, respectively （P〈0.01, P〈0.01）. Logistic regression showed the good relationship between pulmonary infection and TPA,WBC count and RSCM （P=0.03 ,P=0.01, P〈0.01）. Conclusion：TPA,WBC count and RSCM could be used for judgment of pulmonary infection. For APP patients that show pneumonia related symptoms in short time after poisoning, early empirical use of antimicrobial could be considered.