敌草快混合百草枯中毒患者临床特点分析

Clinical characteristics of patients with paraquat mixed with diquat poisoning

目的探讨敌草快(DQ)混合百草枯(PQ)中毒患者的临床特点。方法回顾性分析2016年1月20日至2022年3月31日温州医科大学附属第一医院急诊科收治的145例百草枯、敌草快中毒患者的临床资料,分为混合组、百草枯组(PQ组)和敌草快组(DQ组)。对比三组临床指标、器官功能不全,不同中毒剂量与预后的差异。根据混合组患者90 d存活情况分为生存组与死亡组,对比生存组与死亡组各指标差异。将各指标进行Kaplan-Meier生存分析,经Log-Rank检验后采用多因素Cox回归分析混合组患者死亡危险因素。结果共纳入混合组31例,PQ组92例,DQ组22例。三组对比年龄、中毒量、器官功能不全个数、PSS评分和APACHE II评分有统计学意义(P<0.05)。混合组主要损伤器官为肠道、肾脏、肝脏、肺脏和神经系统,各器官损伤比例高于PQ组和DQ组。三组对比白细胞计数、中性粒细胞计数、HB、肌酐、AST、乳酸、PT和APTT有统计学意义(P<0.05)。混合中毒组口服<20 mL均存活,口服20~50 mL共8例,均死亡,口服51~100 mL共11例,死亡8例(72.7%),口服>100 mL共10人,死亡9人(90%)。混合中毒组中敌草快浓度>5000 ng/mL患者均死亡。31例混合中毒患者中有30例(96.78%)患者毒物检测敌草快浓度明显高于百草枯浓度。混合中毒患者生存组与死亡组性别、年龄、中毒至入院时间、中毒剂量、淋巴细胞计数、Hb、BNU、CK、总胆红素、pH、PT无统计学意义(P>0.05),多因素Cox回归分析显示,中毒剂量、入院血浆PQ浓度、入院血浆DQ浓度、乳酸为患者死亡的独立危险因素(P<0.05)。结论敌草快混合百草枯中毒可造成多器官功能损伤,主要损伤脏器为肠道、肾脏、肝脏、肺脏、神经系统。混合中毒相比PQ或DQ中毒具有更高的脏器损伤发生率,病情更加严重,具有更高的病死率。中毒剂量、入院血浆PQ浓度、入院血浆DQ浓度、乳酸为混合除草剂中毒预后的独立影响因素。

Objective To explore the clinical characteristics of patients with paraquat mixed with diquat poisoning.Methods The clinical data of 145 patients with paraquat mixed with diquat poisoning admitted to the Department of Emergency of the First Affiliated Hospital of Wenzhou Medical University from January 20,2016 to March 31,2022 were retrospectively analyzed.According to the detection results of plasma toxicants in patients with poisoning,the patients were divided into the paraquat diquat mixed group(mixed group),paraquat group(PQ group)and diquat group(DQ group).The clinical indexes,organ dysfunction,different poisoning doses and prognosis of the three groups were compared.Patients in the mixed group were divided into the survival group and death group according to their 90-day survival,and the differences of each index between the two groups were compared.Kaplan-Meier survival analysis was conducted for each index.After Log-rank test,multivariate Cox regression was used to analyze the risk factors of death in the mixed group.Results A total of 31 patients were included in the mixed group,92 patients in the PQ group,and 22 patients in the DQ group.There were significant differences in age,toxic dose,number of organ dysfunction,PSS score and APACHE II score among the three groups(P<0.05).The main injured organs of the mixed group were gastrointestinal tract,kidney,liver,lung and nervous system.The proportion of organ damage in the mixed group was higher than that in the PQ group and DQ group.The white blood cell count,neutrophil count,HB,creatinine,AST,lactic acid,PT and APTT were statistically significant among the three groups(P<0.05).In the mixed group,patients taking oral administration of<20 mL all survived;8 patients taking oral administration of 20-50 mL died;11 patients took oral administration of 51-100 mL and 8(72.7%)died;and 10 patients took oral administration of more than 100 mL and 9 patients(90%)died.In the mixed group,patients with the concentration of diquat>5000 ng/mL died.Among 31 patients with mixed poisoning,30 patients(96.78%)had significantly higher concentrations of diquat than paraquat.There were no significant differences in sex,age,time from poisoning to hospitalization,ingestion amount,lymphocyte count,Hb,BNU,CK,total bilirubin,PH,and PT between the survival group and the death group(P>0.05).Multivariate Cox regression analysis showed that the ingestion amount,plasma PQ concentration at admission,plasma DQ concentration at admission,and lactic acid were independent risk factors for death(P<0.05).Conclusions Paraquat mixed with diquat can cause multiple organ function damage.The main damaged organs are gastrointestinal tract,kidney,liver,lung and nervous system.Compared with PQ or DQ poisoning,mixed poisoning has a higher incidence of organ damage,a more serious condition,and a higher mortality rate.Ingestion amount,plasma PQ concentration at admission,plasma DQ concentration at admission and lactic acid were independent factors influencing the prognosis of mixed poisoning.