71例急性敌草快中毒患者死亡危险因素分析

Analysis of risk factors for death in 71 cases of diquat poisoning

目的探讨急性敌草快中毒患者死亡的危险因素。方法回顾性分析2015年6月至2020年9月中国医科大学附属盛京医院急诊科收治的71例急性敌草快中毒患者的临床资料。依据随访结果将患者分为存活组和死亡组,对比2组患者的一般资料和实验室检测结果,采用logistic回归分析急性敌草快中毒患者死亡危险因素,并通过受试者操作特征(ROC)曲线评价其预测死亡的效能。结果71例患者中,男46例,女25例,平均年龄(41.25±15.78)岁,存活组46例,死亡组25例,死亡率36%。2组性别、年龄、服药时间、白细胞计数、凝血酶原时间、D-二聚体、肌钙蛋白Ⅰ、动脉氧分压、血液实际碳酸氢盐、乳酸等无统计学差异。影响急性敌草快中毒患者死亡的单因素有服药剂量、尿液敌草快浓度、血清肌酐、尿素、谷草转氨酶、SIRS评分和APACHEⅡ评分(P<0.05),服药剂量、尿液敌草快浓度、血清肌酐值与APACHEⅡ评分是急性敌草快中毒患者死亡的独立危险因素(P<0.05)。结论急性敌草快中毒死亡率高,服药剂量、尿液敌草快浓度、血清肌酐值与APACHEⅡ评分是急性敌草快中毒死亡的危险因素,APACHEⅡ评分可帮助临床医生更准确地预测敌草快中毒患者的预后。

Objective To explore the risk factors associated with death in patients presenting as acute cases of diquat poisoning.Methods Clinical data of 71 patients with acute diquat poisoning were collected from the Emergency Department of Shengjing Hospital of China Medical University,from June 2015 to September 2020;the data were then retrospectively analyzed.The patients were then divided accordingly into survival and death groups,based on clinical outcomes determined upon follow-up.General data and test results were compared between the two groups.Logistic regression was used to conduct multivariate analysis for risk of death among patients with acute diquat poisoning;the efficacy of these variables in predicting death was evaluated by a receiver operating characteristic curve.Results All 71 patients were included in the study,including 46 males and 25 females,with an average age of 41.25±15.78 years old.Among them,46 were in the group that survived(64%),and 25 were in the group that died(36%).The overall mortality rate was 36%.The individual factors affecting death of the patients with acute diquat poisoning were toxic dose exposure,urinary diquat concentration,serum creatinine,blood urea,aspartate transaminase,SIRS scores,and APACHEⅡscores(P<0.05).Conclusion The mortality rate of patients with acute diquat poisoning is high.Toxic dose exposure,urinary diquat concentration,serum creatinine,SIRS scores,and APACHEⅡscores are the risk factors for death among patients with acute diquat poisoning.Furthermore,APACHEⅡscores can help clinicians predict the prognosis of patients with diquat poisoning more accurately.