Objective To investigate the clinical value of combining early urine paraquat early clearance rate (UPCR) with severity index of paraquat poisoning (SIPP) in predicting the prognosis for paraquat poisoning patients.Methods In this retrospective research,a total of 425 cases diagnosed with acute paraquat poisoning from March 2014 to March 2016 in Emergency Intensive Care Unit,First Affiliated Hospital of China Medical University were enrolled.The general data of patients,the results of rapid qualitative test of paraquat in blood and urine,the concentration of paraquat in blood / urine,the poisoning time,the concentration of blood lactic acid and the APACHE Ⅱ score were collected.The early UPCR and SIPP were measured at different time intervals,and the ratio of 6-SIPP and 12 h-UPCR were calculated.These patients were divided into death groups and survival groups according to the 28-day mortality.The relationship between these factors and the mortality were analyzed.Results Of all the 425 patients,268 cases (63.1％) died,157 cases (36.9％) survived;the blood concentration of paraquat,the lactate concentration,SIPP values and the APACHE Ⅱ scores were significant difference between the two groups (P ＜ 0.05).The mortality of 2-6 hour paraquat rapid qualitative test result positive patients was higher (96.4％) than that of the negative patients (3.6％) (P ＜ 0.05);the mortality of 12-24 hour paraquat rapid qualitative test result negative patients was lower (11.5％) than that of the positive patients (88.5％) (P＜0.05).The 2-6 hour SIPP value was 19.8 ±6.7 in death group,which was higher than that in survival group (4.9±3.1) (P＜0.05);the 2-6 hour UPCR value was (41.7±9.3) indeath group,which was lower than that in survival group (86.3 ± 15.8) (P ＜ 0.05).There was no significant difference in the 2-6 hour UPCR value and 12-24 hour UPCR value between two groups (P ＞0.05).The 6 h-SIPP/12 h-UPCR value was (41.94 ±5.9) in death group,which was higher than that in survival group (5.27 ± 3.6) (P ＜ 0.05).Conclusion The combined use of early UPCR and SIPP values is an effective indicator of the prognosis of patients with acute paraquat poisoning and is helpful for the early stratification.We should pay more attention to the patients whose rapid qualitative blood test is positive because of their high mortality risk;for the patients whose 12 h urinequalitative test was negative,the hemoperfusion therapy might be stopped because the toxin was completely excluded,and the medical resources can be saved reasonably.The UPCR might indicate the excretion of toxins,and SIPP might indicate the severity of poising.%目的 探讨联合应用早期尿液百草枯清除率(UPCR)及百草枯中毒严重指数(SIPP)对急性百草枯中毒患者预后评估的临床价值.方法 回顾性分析从2014年3月到2016年3月中国医科大学附属第一医院急诊科收治的425例急性百草枯中毒患者,收集患者的一般资料、血液/尿液百草枯快速定性试验结果、各时间点血液/尿液百草枯浓度、服毒中毒到就诊的时间、血乳酸浓度、APACHEⅡ评分值等,统计患者不同时间段的早期尿液百草枯清除率和百草枯中毒严重指数并计算出6 h-SIPP与12 h-UPCR的比值.根据患者在28 d内的生存情况将患者分为死亡组和存活组,分别研究以上因素对患者预后的影响.组间数据比较采用独立样本t检验分析,Mann-Whitney U检验及Pearson x2检验,以P＜0.05为差异有统计学意义.结果 在425例入选的急性百草枯中毒患者中有268例(63.1％)死亡,157例(36.9％)存活;存活组和死亡组比较,入院时的血液百草枯浓度、血乳酸浓度、SIPP值和APACHEⅡ的差异有统计学意义(P＜0.05);患者服毒2～6h内血液快速定性试验阳性组的病死率为96.4％,明显高于血液快速定性试验阴性组3.6％,差异有统计学意义(P＜0.05);患者服毒12 ～24 h尿液快速定性试验转阴组的病死率为11.5％,明显低于尿液快速定性试验阳性组88.5％,差异有统计学意义(P＜0.05);患者服毒2～6h的SIPP值死亡组为(19.8±6.7),存活组为(4.9±3.1),差异有统计学意义(P＜0.05);患者服毒6～12h的UPCR死亡组为(41.7±9.3),明显低于存活组(86.3±15.8),两组间差异有统计学意义(P＜0.05),SIPP值死亡组为(4.8±2.5),存活组为(1.3±1.1),差异无统计学意义(P＞0.05);患者服毒12 ～24 h的UPCR死亡组为(26.7±4.3),存活组为(13.6±3.1),两组间差异无统计学意义(P＞0.05);死亡组的6 h-SIPP/12 h-UPCR值为(41.94±5.9),明显高于存活组(5.27±3.6),差异有统计学意义(P＜0.05).结论 联合应用早期UPCR及SIPP值是对急性百草枯中毒患者预后评估的有效指标,有助于临床上对急性百草枯患者进行早期分层.对于服毒6h血液快速定性试验仍然阳性的患者,因其病死率极高,临床上应给予重视;对于服毒12h尿液快速定性试验阴性的患者,因为毒素基本完全排除体外,可以考虑终止血液灌流治疗,合理节省医疗资源.患者的UPCR能反映体内毒素排出情况,SIPP反映患者中毒的严重程度.
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