摘要
目的 分析敌草快和百草枯中毒患者的靶器官损害特点,为进一步提高临床救治水平提供科学依据。方法 回顾性收集88例单纯经口服敌草快中毒患者(敌草快组)和80例百草枯中毒患者(百草枯组)的临床资料,包括年龄、性别、中毒剂量、中毒到入院时间、中毒催吐导泻情况、中毒到洗胃时间、临床表现、中毒到第一次血液灌流时间、血液灌流次数、住院天数、肝肾功能[丙氨酸氨基转移酶(ALT)、总胆红素(TBIL)、肌酐(Cr)]、凝血功能[凝血酶原时间(PT)]、白细胞计数(WBC)、肺损伤指标[氧合指数(PO2/FiO2)]、心肌损伤指标[肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnI)]、血乳酸(Lac)、pH值及最终预后等指标。比较敌草快组和百草枯组患者的临床资料差异及不同中毒剂量死亡率与存活率及总体存活率;比较敌草快组和百草枯组死亡患者靶器官功能受损情况;比较死亡患者与存活患者敌草快和和百草枯的中毒剂量。结果 敌草快组年龄最大73岁,最小15岁;百草枯组年龄最大59岁,最小14岁;敌草快组男性34例(38.64%),女性54例(61.36%);百草枯组男37例(46.25%),女43例(53.75%);两组中毒后均以咽喉部疼痛、恶心、呕吐、上腹疼痛为主要临床表现,少部分中毒剂量少的患者可没有任何症状;百草枯组中毒剂量>50 ml的患者出现胸闷气促症状,敌草快组中毒剂量>50 ml的患者出现意识烦躁、嗜睡、谵妄甚至抽搐、昏迷等症状。两组性别、平均年龄、平均中毒剂量、平均中毒到入院时间、中毒催吐导泻率、平均中毒到洗胃时间、平均中毒到第一次血液灌流时间、平均血液灌流次数比较无明显差异(P>0.05);敌草快组的平均住院天数(4.86±1.81)d明显短于百草枯组的(7.85±1.13)d(P<0.05)。中毒剂量21~50 ml和51~100 ml时,敌草快组存活率均高于百草枯组(P<0.05);敌草快组总体存活率78.41%明显高于百草枯组的37.50%(P<0.05)。入院后第3天,敌草快组死亡患者ALT(109.26±63.88)U/L、TBIL(40.29±10.39)μmol/L、PT(12.24±1.56)s、Lac(1.54±1.09)mmol/L及WBC(13.24±3.43)×109/L均低于百草枯组死亡患者的(327.12±127.86)U/L、(68.38±48.55)μmol/L、(17.39±2.73)s、(4.53±1.54)mmol/L、(23.32±4.56)×109/L,Cr(308.44±156.87)μmol/L、PO2/FiO2(207.32±76.10)mm Hg(1 mm Hg=0.133 kPa)、CK(456.56±101.39)U/L、CK-MB(63.29±21.39)U/L、cTnI(11.56±1.31)ng/ml均高于百草枯组死亡患者的(201.93±87.01)μmol/L、(153.25±64.25)mm Hg、(50.29±21.39)U/L、(47.21±12.22)U/L、(4.29±4.21)ng/ml(P<0.05)。死亡患者敌草快和百草枯中毒剂量均明显高于存活患者(P<0.05);死亡患者敌草快中毒剂量大于百草枯(P<0.05);存活患者敌草快和百草枯中毒剂量无明显差异(P>0.05)。结论 敌草快和百草枯中毒患者的年龄以40岁以下中青年女性多见,所有口服中毒患者均出现咽痛、恶心、呕吐等消化道症状;敌草快口服中毒剂量大者会出现意识改变,包括烦躁、嗜睡、抽搐、昏迷等,而百草枯中毒剂量大者会出现胸闷气促等症状;服用同等剂量除草剂,敌草快存活率高于百草枯;敌草快以肾、心肌及神经系统损伤最为显著,且与患者预后密切相关;百草枯中毒以肺、肝和肾脏损伤为主;敌草快中毒患者总体死亡率低于百草枯中毒死亡率。
Objective To analyze the characteristics of target organ damage in patients with diquat and paraquat poisoning in order to provide scientific basis for further improving the clinical treatment level.Methods The clinical data of 88 patients with simple oral diquat(diquat group)and 80 patients with paraquat poisoning(paraquat group)were retrospectively collected,including age,sex,poisoning dose,time from poisoning to admission,poisoning induced vomiting and diarrhea,time from poisoning to gastric lavage,clinical manifestation,time from poisoning to first hemperfusion,number of hemoperfusion,hospitalization days,liver and kidney function[ alanine aminotransferase (ALT), total bilirubin (TBIL), creatinine (Cr)], blood coagulation function [prothrombin time (PT)], white blood cell count (WBC), indicators of lung injury[ oxygenation index (PO2/ FiO2)], indicators of myocardial injury[ creatine kinase (CK), creatine kinase isoenzyme (CK-MB), troponin I (cTnI)], blood lactic acid (Lac), pH value and final prognosis. Comparison was made on the difference of the above clinical indicators between diquat group and paraquat group, the target organ damage in patients who died in diquat group and paraquat group, and the poisoning doses of diquat and paraquat in dead and surviving patients. Results In the diquat group, the maximum age was 73 years old and the minimum age was 15 years old;in the paraquat group, the maximum age was 59 years old and the minimum age was 14 years old;in the diquat group, there were 34 cases of males (38.64%) and 54 cases of females (61.36%);in the paraquat group, there were 37 cases of males (46.25%) and 43 cases of females (53.75%). Throat pain, nausea, vomiting and epigastric pain were the main clinical manifestations in both groups after poisoning. A few patients with low dose of poisoning had no symptoms. In paraquat group, patients with poisoning dose more than 50 ml showed symptoms of chest tightness and shortness of breath, while in diquat group, patients with poisoning dose more than 50 ml showed symptoms of irritability, drowsiness, delirium or even convulsions, coma and so on. There was no significant difference between the two groups in terms of sex, average age, average poisoned dose, average time from poisoning to admission, rate of poisoning induced vomiting and diarrhea, average time from poisoning to gastric lavage, average time from poisoning to the first hemoperfusion, and average number of hemoperfusion (P>0.05). The average hospitalization days in the diquat group was (4.86±1.81) d, which was significantly shorter than (7.85±1.13) d in the paraquat group (P<0.05). The survival rate of the diquat group was higher than that of the paraquat group at poisoning doses of 21-50 ml and 51-100 ml (P<0.05). The overall survival rate of 78.41% in the diquat group was significantly higher than 37.50% in the paraquat group (P<0.05). On the 3rd day after admission, ALT of dead patients in the diquat group was (109.26±63.88) U/L, TBIL was (40.29±10.39) μmol/L, PT was (12.24±1.56) s, Lac was (1.54±1.09) mmol/L, and WBC was (13.24±3.43)×109/L, which were lower than (327.12±127.86) U/L, (68.38±48.55) μmol/L, (17.39±2.73) s, (4.53±1.54) mmol/L, and (23.32±4.56)×109/L of dead patients in the paraquat group;Cr of dead patients in the diquat group was (308.44±156.87) μmol/L, PO2/FiO2 was (207.32±76.10) mm Hg (1 mm Hg=0.133 kPa), CK was (456.56±101.39) U/L, CK-MB was (63.29±21.39) U/L, cTnI was (11.56±1.31) ng/ml, which were higher than (201.93±87.01) μmol/L, (153.25±64.25) mm Hg, (50.29±21.39) U/L, (47.21±12.22) U/L, (4.29±4.21) ng/ml of dead patients in the paraquat group (P<0.05). The poisoning doses of diquat and paraquat in dead patients were significantly higher than those in the surviving patients (P<0.05). The poisoning dose of diquat in dead patients was greater than that of paraquat (P<0.05). There was no significant difference in the poisoning doses of diquat and paraquat in surviving patients (P>0.05). Conclusion The age of the patients with diquat and paraquat poisoning is more common in young and middle-aged women under 40 years old, all patients with oral poisoning have digestive tract symptoms such as sore throat, nausea, vomiting;patients with large doses of diquat poisoning will have consciousness changes including irritability, lethargy, convulsion, coma, while patients with large doses of paraquat poisoning will have chest tightness, shortness of breath and other symptoms. Taking the same dose of poisoing, the survival rate of diquat was higher than that of paraquat;diquat has the most significant damage to kidney, myocardium and nervous system and is closely related to the prognosis of patients. Paraquat poisoning mainly damages lung, liver and kidney and the overall mortality rate of patients poisoned by diquat is lower than that of paraquat poisoning.
作者
田贺岚
吉春玲
朱加应
任亦频
TIAN He-lan;JI Chun-ling;ZHU Jia-ying(Department of Emergency,Guizhou Provincial People's Hospital,Guiyang 550002,China)
出处
《中国实用医药》
2024年第11期41-45,共5页
China Practical Medicine
关键词
敌草快
百草枯
中毒
靶器官损害
Diquat
Paraquat
Poisoning
Target organ damage
作者简介
通讯作者:吉春玲。
