| This paper is divided into tow partsThe first part:Clinical Research on Inflammatory Reaction Concerned about Acute Paraquat PoisoningBackgroudAcute paraquat intoxication is a common pesticide poisoning in present emergency work, which causes unclear damage of body and high morbidity. As for current study, its Inflammatory reaction has key influnce on the progress of the illness development.ObjectiveAnalyze the features of all clinical index of Inflammatory reaction for patients with acute paraquat intoxicationMethodCollect 212 patients with acute paraquat intoxication in emergency ward of the First Affiliated Hospital of Zhengzhou University from December 2009 to January 2011. The patients are all oral poisoning. When they are taken to hospital, they are inspeacted about all clinical inflammatory reaction index and during the time they are in hospital, the patienta get regular reviews. Besides establish control group, divide tne patients into groups according to their poisoning dose and prognosis after one month. Analyze the relationship between all clinical inflammatory reaction index and patients'prognosis, poisoning dose.Result1. There is no satistics meaning of the comparative differences in this study among patients'age, sex, time from taking poison to being hospitalized separately belonging to all JLH, prognostic groups, control groups (p>0.05). Patients have no bias on choices.2. Compared with control groups, patients with acute paraquat intoxication have higher numerical value about numeration of leukocyte when patients are sent into hospital (14.25±6.41), leukocyte peak number (16.87±6.67) neutrophilic granulocyte count when patients are hospitalized (12.15±6.24) peak numder of neutrophile granulocyte (14.06±6.46), CRP level when patients are admitted to hospital (15.16±12.84), CRP peak number (24.33±19.53), lactic acid concentration of artery blood of when admitted to hospital (2.03±2.65), peak number of lactic acid concentration of artery blood (3.23±2.66),glucose levels when patients are taken to hospital (8.30±3.18) glucose peak number (8.48±3.79),which has statistics meaning (P均<0.001). there is statistics significance of the differences (P=0.000,0.000,0.000,0.000, 0.000,0.000,0.000,0.000,0.000,0.000,0.001,0.001) among survival group (11.58±4.44) and death group (22.10±5.82) of numeration of leukocyte when patients are sent into hospital, survival group (13.02±4.18) and death group(22.10±5.82) of leukocyte peak number, survival group (9.53±4.37) and death group (15.71±6.63) of neutrophilic granulocyte count when patients are hospitalized,survival group (10.45±4.23) and death group (18.96±5.69)of peak numder of neutrophile granulocyte,survival group (9.35±9.27) and death group (23.04±12.85) of CRP level when patients are admitted to hospital, survival group (12.34±10.06) and death group (40.59±17.38) of CRP peak number, survival group (1.56±1.34) and death group (2.67±2.73) of lactic acid concentration of artery blood of when admitted to hospital, survival group (2.05±1.29) and death group (4.84±3.36) of peak number of lactic acid concentration of artery blood, survival group (7.59±2.17) and death group (9.24±3.99) of glucose levels when patients are taken to hospital, survival group (7.78±2.36) and death group (9.43±4.08) of glucose peak number. And with the increase of poison dose, they all have the trend to rise. The number of each index when patients are taken to hospital, peak number and the number of prognosis of leukocyte, neutrophile granulocyte, lactic acid concentration of artery blood, glucose are positively related (rare separately 0.498,0.494,0.609,0.463,0.344,0.716,0.684,0.745,0.587,0.426). Compared with control groups, the number of admission arterial blood gas PaCO2 (30.51±6.56) and valley value of admission arterial blood gas PaCO2 (29.73±6.47) of patients with acute paraquat intoxication are rather lower and the differerces are statistics significant (P is equallysmaller than 0.001). The level of admission arterial blood gas PaCO2 and the valley value of admission arterial blood gas PaCO2 of death group are lower than survival group (33.30±5.52),(32.65±5.24) and this difference has statistics significance (P<0.001). And with the increase of poison dose, they are on a declining curve and nagetively related to prognosis (r are separately 0.510,-0.619)ConclusionThere are increases during thedisease development of patients with acute paraquat intoxication of all reaction index of the inflammatory response of numeration of leukocyte, numeration of leukocyte, CRP, lactic acid concentration of artery blood and glucose and the decrease of blood gas PaCO2 is connected with prognosis. This points out that inflammatory response has a key effect on the desease development of acute paraquat intoxication.The second part:the Study of the Grading Systems of APACHEⅡ. SAPSⅡ,MODS,SOFA and PSS on the Prognostic Evaluation of Acute Paraquat PoisoningBackgroudThe state of acute paraquat intoxication is complicated. Only depending on the estimated poisoning dose and clinical experience to judge the severity of the desease and evaluate the prognosis can not meet clinical demands. ObjectiveEvaluate adaptability of these five grading systems to acute paraquat intoxication and transversely compare the goodness and badness of their ability to evaluate.MethodCollect 105 patients with acute paraquat intoxication in emergency ward of the First Affiliated Hospital of Zhengzhou University from December 2009 to January 2011. The patients are all oral poisoning and they get APACHEⅡSAPSⅡMODS,SOFA and PSS evaluation when they are admitted to hospital. At the same time, recod the highest number of four grading systems. Divide patients into groups accoding to their poisoning dose and prognosis after one month. Compare the goodness and the badness of prognostic assessment capacity of four grading systems on acute paraquat intoxication.Result1. There is no satisics meaning of the comparative differences in this study between survival group and death group about patients'age, sex, time from taking poison to being hospitalized. Patients have no bias on choices.2. There is statistics meaning of the differences(P均<0.001)of the comparetion of Each rating scores of the initial and the highest APACHEIK SOFA,MODS,SAPSⅡPSS grading death group (9.46±3.62,18.63±10.72,4.11±2.10, 7.91±3.82,2.48±1.60,6.57±3.56,20.54±7.21,34.33±14.22,1.96±0.52,2.78±0.42) and survival group (3.25±1.74,3.95±2.26,1.31±1.52, 1.81±1.59,0.83±1.13,1.17±1.32,11.37±4.63,13.81±5.78,1.07±0.49, 1.42±0.65)3. Curve area under the initial APACHEⅡSOFA,MODS,SAPSⅡPSS grading and the highest APACHEⅡSOFA,MODS,SAPSⅡPSS grading are separately 0.925,0.854,0.800,0.832,0.862,0.967,0.907,0.903,0876,0.930. They are all greater or equal to 0.8 and have nice predictive ability. For the initial grading and the highest grading, AUC of APACHEII ranks the first high and then the second is PSS. The initial SOFA grading is better than MODS grading. Except that there is no statistics meaning of the difference of ROC curve area under the highest SAPSⅡand the initial SAPSⅡ(P=0.061), the highest grading of the rest is better than the initial grading and it has statistics meaning (P=0.046,0.048,0.002,0.046)ConclusionDuring the prognostic evaluation on acute paraquat intoxication by implying grading systems, APACHEⅡ,PSS grading systems are better than other grading systems and the ability to predict the highest score is better than the initial. |
PDF Full Text Request