83例急性草甘膦除草剂中毒患者临床特征分析

Clinical characteristics of 83 patients with acute glyphosate herbicide poisoning

目的分析急性草甘膦除草剂中毒患者的临床特征及不同中毒严重程度的差异。方法选取郑州大学第一附属医院2014年1月至2020年12月收治的急性草甘膦除草剂中毒患者进行回顾性分析。收集患者的一般资料、接触时间、中毒剂量、中毒原因、中毒途径、临床表现、住院期间实验室检查结果、治疗方式、住院时间、预后等信息,并根据2016年《急性中毒诊断与治疗中国专家共识》的中毒严重程度评分标准进行病情分级,以住院期间最高病情分级为最终病情分级,根据病情分级结果,无症状和轻度纳入轻症组,中度、重度和死亡纳入严重组。对计量资料采用独立样本t检验或Mann-Whitney U检验,对计数资料采用χ^(2)检验或Fisher精确检验,比较两组患者一般资料、临床资料的差异。结果根据纳入和排除标准最终确定83例急性草甘膦除草剂中毒患者为研究对象,全部患者均存活,主要为轻度中毒(56.6%),男女比例为33∶50,平均年龄为39岁。病例数呈逐年上升趋势(2019年最高),且多发于春夏季节。主要中毒原因和中毒途径分别为自杀(71.1%)和直接口服(83.1%),临床表现以消化系统症状为主(71.1%)。实验室检查多见白细胞计数(white blood cell count,WBC)、中性粒细胞百分比(neutrophil percentage,NEUT%)、D-二聚体升高和血红蛋白、血钾降低。与轻症组相比,严重组平均年龄更大[(51±17)岁vs.(35±19)岁]、自杀和直接口服占比更高、住院时间更长[8.0(4.8,12.0)d vs.3.0(2.0,5.5)d]、中毒剂量更大[200.0(50.0,200.0)mL vs.30.0(11.3,57.5)mL]、入院24 h内NEUT%更高[(83.4±10.4)vs.(73.2±12.8)]。严重组较轻症组更易发生WBC、NEUT%、谷草转氨酶、凝血酶原时间、D-二聚体等指标升高和血钾降低,差异均有统计学意义(均P<0.05)。结论急性草甘膦除草剂中毒患者有逐年增多的趋势,一般病情较轻、预后较好,中老年人、直接口服、中毒剂量高和入院24 h内NEUT%高的患者病情更重,严重中毒更易引起实验室指标变化。

Objective To analyze the clinical characteristics of patients with acute glyphosate herbicide poisoning and the differences in the severity of poisoning.Methods A retrospective analysis was performed on patients with acute glyphosate herbicide poisoning admitted to the First Affiliated Hospital of Zhengzhou University from January 2014 to December 2020.The general information,exposure time,poisoning dose,poisoning cause,poisoning route,clinical manifestations,laboratory examination results during hospitalization,treatment measures,hospital stays and prognosis of the patients were collected.The patients were graded according to the poisoning severity scoring standard of Chinese Expert Consensus on Diagnosis and Treatment of Acute Poisoning in 2016.The highest severity score during hospitalization was used as the final grade.According to the final grade,asymptomatic and mild patients were included in the mild group,and moderate,severe and death patients were included in the severe group.The independent sample T test or Mann-Whitney U test was used for measurement data,and χ^(2) test or Fisher's exact test was used for counting data.The differences of general data and clinical data between the two groups were compared.Results According to the inclusion and exclusion criteria,83 patients with acute glyphosate herbicide poisoning were selected as the study subjects.All patients survived,mainly mild poisoning(56.6%),with a male to female ratio of 33∶50,and an average age of 39 years.The number of poisoning cases increased yearly(the highest in 2019),and most cases occurred in spring and summer.The main cause of poisoning was suicide(71.1%),direct oral administration(83.1%)was the primary route of poisoning,and the dominating clinical manifestations were digestive symptoms(71.1%).Laboratory tests showed increased white blood cell count(WBC),neutrophil percentage(NEUT%)and D-dimer,and decreased hemoglobin and potassium.Compared with the mild group,patients in the severe group were older[(51±17)years vs.(35±19)years],had a higher proportion of suicide and direct oral administration,a longer hospital stay[8.0(4.8,12.0)d vs.3.0(2.0,5.5)d],a higher dose of poisoning[200.0(50.0,200.0)mL vs.30.0(11.3,57.5)mL],and higher NEUT%within 24 h of admission[(83.4±10.4)vs.(73.2±12.8)].The increase of WBC,NEUT%,aspartate aminotransferase,prothrombin time,D-dimer and the decrease of serum potassium were more common in the severe group than the mild group,with statistical significance(all P<0.05).Conclusions The number of patients with acute glyphosate herbicide poisoning is increasing yearly.Generally,the condition is mild and the prognosis is satisfying.The severity is more serious in the middle-aged and elderly patients andthose with direct oral administration,high toxic dose,and high NEUT%within 24 h of admission.Severe poisoning is more likely to cause changes in laboratory indicators.