急性百草枯中毒患者并发MODS的危险因素及治疗探讨

Risk factors and treatment of MODS in patients with acute paraquat poisoning

目的:探讨急性百草枯中毒患者并发多器官功能障碍综合征(MODS)的危险因素,并研究其治疗方案。方法:回顾性分析阜阳市人民医院急诊科2017-01—2020-01期间收治的68例急性百草枯中毒患者的临床资料,计算MODS发生率,采用SPSS 24.0软件明确并发MODS的危险因素;统计并发MODS患者的治疗措施及死亡情况。结果:MODS发生率为72.06%;MODS发生者年龄>60岁、口服中毒、中毒至就诊时间>1.5h、入院时血百草枯浓度>0.5μmol/L、中毒至洗胃时间>2h占比均高于MODS未发生者,差异均有统计学意义(P<0.05),且均经Logistic回归分析证实为并发MODS的独立危险因素(P<0.05);MODS发生者甲强龙强化治疗占比低于未发生者,差异有统计学意义(P<0.05),且经Logistic回归分析证实为并发MODS的保护因素(P<0.05);纳入患者的病死率为82.35%,MODS发生者病死率为95.92%,高于MODS未发生者47.37%,差异有统计学意义(P<0.05)。结论:急性百草枯中毒患者并发MODS的风险高,且年龄>60岁、口服中毒、中毒至就诊时间>1.5h、入院时血百草枯浓度>0.5μmol/L、中毒至洗胃时间>2h均是其危险因素,甲强龙强化治疗是其保护因素,此类患者死亡风险高,尤其是并发MODS者,需加强治疗。

Objective:To explore the risk factors and the treatment plan of MODS in patients with acute paraquat poisoning.Method:The clinical data of 68patients with acute paraquat poisoning in emergency department of Fuyang People's Hospital from January 2017to January 2020were analyzed retrospectively,and the incidence of MODS was calculated,and SPSS24.0software was used to identify the risk factors of MODS.The treatment methods and mortality of MODS patients were analyzed.Result:The incidence of MODS was 72.06%.The rates of age>60years old,the time from poisoning to treatment>1.5h,the concentration of paraquat>0.5μmol/L,the time from poisoning to gastric lavage>2hof patients with MODS were higher than those without MODS,and the differences were statistically significant(P<0.05),then the Logistic regression analysis confirmed that they were independent risk factors for MODS(P<0.05).In MODS patients,the proportion of intensive treatment with methylprednisolone of patients was lower than that without methylprednisolone,with a statistically significant difference(P<0.05),and it was a protective factor of MODS confirmed by Logistic regression analysis(P<0.05).The total mortality was 82.35%and the mortality patients with or without MODS were respectively were 95.92%and 47.37%,with a statistically significant difference(P<0.05).Conclusion:Patients with acute paraquat poisoning are at high risk of MODS,and age>60years old,the time from poisoning to treatment>1.5 h,the concentration of paraquat>0.5μmol/L,the time from poisoning to gastric lavage>2hare risk factors,while intensive treatment with methylprednisolone is a protective factor.This kind of patients have a high risk of death,especially those with MODS,and need to strengthen targeted treatment.