百草枯中毒严重指数及血气分析对急性百草枯中毒患者预后的影响

Influence of the severity index of paraquat poisoning combined with blood gas analysis on the prognosis of patients suffered acute paraquat poisoning

目的探讨百草枯中毒严重指数(SIPP)及动脉血气分析变化在急性百草枯中毒患者预后评估中的作用。方法选取2013年1月—2017年1月期间蚌埠医学院第一附属医院急诊内科收治的急性百草枯中毒患者100例,根据患者服毒后21天的转归分为存活组和死亡组,其中存活组54例,死亡组46例,对其临床资料进行回顾性分析。检测患者入院时的血清百草枯浓度,计算百草枯中毒严重指数。动态监测入院时、入院12 h、入院24 h患者动脉血清乳酸和碱剩余的变化。分析SIPP、乳酸、碱剩余的变化对患者预后评估的价值。结果死亡组患者入院时血浆百草枯浓度及SIPP均显著高于存活组(P<0.001)。动脉血气分析显示入院时、入院12 h、入院24 h死亡组乳酸水平均明显高于存活组,而碱剩余水平均明显低于存活组(P<0.05)。患者SIPP越高,动脉血乳酸水平越高,碱剩余水平越低,患者病死率随之增高,生存天数随之下降,组间比较均具有统计学意义(P<0.05)。Logistic回归分析结果显示SIPP、乳酸和碱剩余水平均与百草枯中毒患者的预后相关。结论计算SIPP及动态检测血清乳酸、碱剩余的变化对百草枯中毒患者的病情严重程度及预后具有评估价值。

Objective To explore the influence of the severity index of paraquat poisoning combined with blood gas analysis on the prognosis of patients suffered acute paraquat poisoning. Methods A total of 100 patients suffered acute paraquat poisoning were admitted to the emergency department of the first affiliated hospital of Bengbu Medical College from January 2013 to January 2017.According to the survival of 21 days,patients were divided into survivor group and death group.Of the 100 cases,54 survived and 46 died in 21 days. The clinical data were retrospectively analyzed. Results Plasma paraquat concentrations and SIPP were significantly higher in death group than in survivor group（ P〈0.001）.Through arterial blood gas analysis,the serum level of lactic acid of the patients suffered paraquat poisoning at the time points admission,12 h after admission and 24 h after admission were significantly higher and Alkali residual level significantly lower in the death group than those in the survival group. Following the higher the SIPP,the higher the lactic acid concentration in serum and the less the base excess of patients,the mortality rate getting higher and the number of days of survival became lower respectively（ P〈0.05）.Logistic regression analysis showed that SIPP,the serum level of lactic acid and base excess were all related to prognosis of the patients suffered paraquat poisoning.Conclusions Calculating the SIPP and dynamic detecting the serum level of lactic acid and base excess has evaluation value on the severity and prognosis of the patients suffered paraquat poisoning.