服毒-血液灌流时间对急性百草枯中毒患者预后的影响

摘要

Objective To explore the influence of the length of time elapsed from ingestion of paraquat to hemoperfusion on prognosis in patients with acute paraquat poisoning.Methods The investigation was carried out with retrospective analysis.A total of 303 patients with acute paraquat poisoning were admitted to the Emergency Intensive Care Unit (EICU) of the First Affiliated Hospital of China Medical University from January 2009 to December 2012.According to the length of time between ingestion and hemoperfusion,patients were divided into three groups,Group A:the time interval between ingestion and hemoperfusion ＜ 4 h ; Group B:4h ≤ the time interval between ingestion and hemoperfusion ＜ 8 h; Group C:8 h≤the time interval between ingestion and hemoperfusion ＜ 12 h.Compared the extent of target organ injury,28-d mortality and the survival time of non-survivors among three groups for determining the influence of the length of time elapsed from ingestion to hemoperfusion on the prognosis of patients.Results Totally 303 patients with average age of 34.8 ± 10.8 years old (ranging from 15 to 72 years),and 117 male and 186 female.The median estimated amount of 20％ paraquat ingested was 50 mL (ranging from 10 to 270 mL,IQR:45 mL).The hemoperfusion was employed (3.6 ±1.2) times (ranging from 2 to 5 times) for every paitient within 24 h after ingestion.The overall mortality rate was 68.6％ (208/304)during a 28 days follow-up period,and only 95 of 303 patients survived.The median length of time between paraquat ingestion and hemoperfusion at the emergency department was 6.6 h (ranging from 1.4 to 11.5 h,IQR:3.5 h).However,it was 7.2 h (ranging from 3.1 to 11.5 h,IQR:2.4 h) in non-survivors and 4.9 h (ranging from 1.4 to 7.6 h,IQR:1.5 h) in survivors.The difference was statistically significant (U =2.014,P =0.043).The difference in 28-day mortality among three groups was statistically significant (x2 =9.27,P =0.009),and the difference in average survival time of non-survivors among three groups was statistically significant (F =3.31,P =0.038).The length of time between ingestion and hemoperfusion and the survival time of non-survivors was a negative correlation (r2 =0.421,P =0.045).The difference in ALTmax,SCrmax,AMYmax and PaO2 min,as the severity indicators of acute liver injury,acute kidney injury,acute pancreas injury and acute lung injury among the three groups were statistically significant (all P ＜ 0.05).Conclusions Employment of hemoperfusion within 4 h after ingestion can attenuate the degree of target organ injury,reducing 28 day mortality of patients with acute paraquat poisoning.%目的 探讨服毒-血液灌流(HP)时间对急性百草枯中毒患者预后的关系.方法 对2009年1月至2012年12月期间中国医科大学附属第一医院急诊监护室(EICU)收治的进行HP治疗的急性百草枯中毒患者的临床资料进行回顾性分析,按照患者服毒后HP开始的时间将患者分为3组,A组:服毒-HP时间＜4h;B组:4h≤服毒-HP时间＜8h;C组:8h≤服毒-HP时间＜12h,比较各组患者的脏器损伤情况、病死率和死亡患者的存活时间等,分析服毒-HP时间对患者预后的影响.结果 共有303例急性百草枯中毒患者纳入本研究,男117例,女186例,年龄15～72岁,(34.8±10.8)岁,口服20％百草枯农药剂量10 ～270 mL,50mL (45 mL) [M (IQR)].服毒24 h内接受HP 2 ～5次,(3.6±1.2)次.经随访28 d死亡208例,病死率68.6％.入选患者服毒至首次HP时间1.4～11.5 h,6.6h (3.5h) [M (IQR)],其中死亡患者为3.1～11.5 h,7.2h (2.4h) [M (IQR)],存活患者为1.4～7.5 h,4.9 h(1.5 h)[M (IQR)],死亡患者服毒至首次HP时间与存活组比较,差异有统计学意义(U=2.014,P=0.043).A组85例,B组141例,C组77例,三组患者28 d病死率比较,差异有统计学意义(x2=9.27,P=0.009).三组中死亡患者中毒后平均存活时间的差异有统计学意义(F =3.31,P=0.038),患者开始HP时间与死亡患者存活时间呈负相关(r2 =0.421,P=0.045).三组患者间进行比较,代表肝、肾、胰腺、肺损伤严重程度的指标如ALTmax、SCrmax、AMYmax和PaO2min在各组之间比较差异有统计学意义(P＜0.05),发生急性肺损伤的时间和PaO2min出现时间在各组间比较差异有统计学意义(F=3.22、3.15,P=0.041、0.044).结论 口服百草枯农药中毒后4h之内进行HP能够减轻靶器官损伤程度,降低患者病死率.