百草枯中毒患者肺肾损伤顺序对预后的影响

doi:10.3877/cma.j.issn.2095-9133.2019.06.007

目的

探讨百草枯中毒患者肺肾损伤顺序对预后的影响。

方法

采用回顾性病例对照研究分析选择2010年10月至2018年8月南昌大学第一附属医院急诊科收治的175例百草枯中毒患者的临床资料，其中男性60例，女性115例；年龄14～79岁，平均(36.55±16.13)岁。将175例百草枯中毒患者根据肺肾损伤先后顺序分为肾损伤先于肺损伤组(A组，68例)，肺损伤先于肾损伤组(B组，42例)和肺肾同时受损伤组(C组，65例)。记录各组服毒量、服毒至洗胃时间、服毒至入院时间、年龄、性别、服毒至肺损伤时间、服毒至肾损伤时间，比较患者预后好转或死亡情况。

结果

(1)三组间服毒至洗胃时间、服毒至入院时间、性别差异无统计学意义(P>0.05)，服毒量、年龄差异存在统计学意义(P<0.01)；但年龄与预后无相关性(P>0.05)，服毒量与预后存在正相关性(P<0.001)。(2)A组预后好于B组，差异存在统计学意义(χ²＝8.319，P<0.05)；B组预后好于C组，差异存在统计学差异(χ²＝21.04，P<0.05)。

结论

百草枯中毒患者中，肺肾同时受损患者预后最差，肾损伤先于肺损伤预后好于肺损伤先于肾损伤者；服毒量对预后也具有较好的判断价值。

关键词: 预后, 肺损伤, 肾损伤, 百草枯中毒

Objective

To investigate the effect of lung and kidney injury sequence on prognosis in patients with paraquat poisoning.

Methods

A total of 175 cases of paraquat poisoning admitted to the emergency department of the First Affiliated Hospital of Nanchang University from October 2010 to August 2018 were analyzed retrospectively, including 60 males and 115 females, aged 14-79 years, with an average age of (36.55±16.13)years. The 175 cases of paraquat poisoning were divided into 3 groups according to the sequence of lung and kidney injury. Renal injury was prior to lung injury group(Group A, 68 cases), lung injury was prior to kidney injury group (Group B, 42 cases), and lung and kidney damage group (group C, 65 cases). The data between each group were recorded, including dose of poisoning, the time from poisoning to gastric lavage, the time from poisoning to admission, age, gender, the time from poisoning to lung damage, and the time from poisoning to kidney damage, to compare the prognosis of patients with improvement or death.

Results

There was no statistically significant difference between the three groups in terms of the time from taking poison to gastric lavage, the time from taking poison to admission, and gender (P>0.05). There were statistically significant differences in the dose and age (P<0.01). However, there was no correlation of age on prognosis (P>0.05), while there was a correlation of dose on prognosis (P<0.001). The prognosis of group A was better than that of group B, and the difference is statistically significant (χ²=8.32, P<0.01); the prognosis of group B was better than that of group C, and the difference was statistically significant (χ²=21.04, P< 0.001).

Conclusion

The order of lung and kidney injury sequence has an impact on the prognosis: patients with simultaneous lung and kidney damage have the worst prognosis; the prognosis of the patient with kidney damage prior to lung damage is better than that of the patient with lung damage prior to kidney damage. The dose of poisoning also has good value for the prognosis.

Key words: Prognosis, lung injury, kidney injury, paraquat poisoning

表1 三组百草枯患者一般临床资料比较

组别	例数	性别(男/女)	年龄(岁，±s)	服毒量(mL，±s)	洗胃时间(min，±s)	入院时间(h，±s)	服毒至肺损伤时间(d，±s)	服毒至肾损伤时间(d，±s)
A组	68	21/47	30.79±13.11	36.88±48.72	92.09±104.50	16.82±23.02	4.43±2.08	2.01±1.19
B组	42	16/26	41.67±17.76	35.05±33.91	69.29±66.46	12.86±16.78	2.19±1.81	3.26±1.88
C组	65	23/42	39.28±16.30	67.31±56.98	82.31±130.02	14.94±233.75	1.69±0.82	1.69±0.82

表1 三组百草枯患者一般临床资料比较

组别	例数	性别(男/女)	年龄(岁，±s)	服毒量(mL，±s)	洗胃时间(min，±s)	入院时间(h，±s)	服毒至肺损伤时间(d，±s)	服毒至肾损伤时间(d，±s)
A组	68	21/47	30.79±13.11	36.88±48.72	92.09±104.50	16.82±23.02	4.43±2.08	2.01±1.19
B组	42	16/26	41.67±17.76	35.05±33.91	69.29±66.46	12.86±16.78	2.19±1.81	3.26±1.88
C组	65	23/42	39.28±16.30	67.31±56.98	82.31±130.02	14.94±233.75	1.69±0.82	1.69±0.82

表2 三组百草枯患者一般临床资料对比

组别	例数	性别(男/女)	年龄[岁，M(P25，P75)]	服毒量[mL，M(P25，P75)]	服毒至洗胃时间[min，M(P25，P75)]	服毒至入院时间[h，M(P25，P75)]
A组	68	21/47	26.0(20.0，40.7)	20.0(10.0，40.0)	60.0(30.0，90.0)	7.0(4.0，14.5)
B组	42	16/26	38.5(28.0，53.2)	20.0(10.0，50.0)	60.0(30.0，60.0)	6.5(4.7，12.0)
C组	65	23/42	38.0(25.0，51.5)	50.0(20.0，100.0)	60.0(30.0，60.0)	6.0(4.0，9.5)
H/χ²值	?	0.39	12.65	16.80	0.46	1.05
P值	?	>0.05	<0.01	<0.01	>0.05	>0.05

表2 三组百草枯患者一般临床资料对比

组别	例数	性别(男/女)	年龄[岁，M(P25，P75)]	服毒量[mL，M(P25，P75)]	服毒至洗胃时间[min，M(P25，P75)]	服毒至入院时间[h，M(P25，P75)]
A组	68	21/47	26.0(20.0，40.7)	20.0(10.0，40.0)	60.0(30.0，90.0)	7.0(4.0，14.5)
B组	42	16/26	38.5(28.0，53.2)	20.0(10.0，50.0)	60.0(30.0，60.0)	6.5(4.7，12.0)
C组	65	23/42	38.0(25.0，51.5)	50.0(20.0，100.0)	60.0(30.0，60.0)	6.0(4.0，9.5)
H/χ²值	?	0.39	12.65	16.80	0.46	1.05
P值	?	>0.05	<0.01	<0.01	>0.05	>0.05

表3 服毒量、年龄与预后相关性

变量	P值	OR值	95%可信区间
服毒量	<0.001	1.04	1.02～1.06
年龄	>0.05	/	/

表3 服毒量、年龄与预后相关性

变量	P值	OR值	95%可信区间
服毒量	<0.001	1.04	1.02～1.06
年龄	>0.05	/	/

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Effect of lung and kidney injury sequence on prognosis in patients with paraquat poisoning

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Effect of lung and kidney injury sequence on prognosis in patients with paraquat poisoning