| Background: Paraquat(paraquat,PQ) is known as duicaokuai、yisaoguang, its20%solution is also called“kewuzong”,it’s chemical name is1，1’-dimethyl-4，4’-bipyridylium dichloride which belongs to a class of bipyridine herbicides.Its almostno contamination,so it is widely used. In recent years, the incidence of paraquatpoisoning(paraquat poisoning,PQP) increased year by year. Paraquat toxicity isintence,and its clinical manifestation is so complicated that there is no effectivetreatment measures and the prognosis is poor. At present the detailed clinical analysis ofparaquat poisoning is less in domestic,so it is significant to study the epidemiologicalcharacteristics and the related factors to prognosis. it is beneficial to estimate theprognosis and guide the treatment.Objective: By retrospective analysis with the clinical data of63acute PQPpatients，research on the clinical feature, characteristics of organ damage and.prognostic factors.Method: Collectting the clinical data of63cases of acute PQP patients treated in emergency medicine office of the second hospital in Jilin University from January2009to december2012, finishing the tables according to the PQP patients data, analysing theclinical feature, characteristics of organ damage. and researching on the prognosticfactors according to death and survival groups from the63cases of acute PQP patientswith different analytical ways.Results: In63patients with PQP,31cases survived and32cases died, themortality rate50.79%; The patients’ ages are from14to59, averaged (29.51±10.67)years old; the main cause of poisoning is suicide (61cases,96.82%); The mainpoisoning way is through the digestive tract (61cases,96.82%).The main clinicalmanifestations is oral mucosa injury (63cases,100%), chest pain (63cases,100%),followed by dyspnea (52cases,82.54%), abdominal distension, abdominal pain (35cases,55.56%).The patients of oliguria or anuria are only8cases (12.70%); Bloodroutine: white blood cells increased in61cases (96.82%); the urine routine: urinaryprotein (+～+++) appears in59cases (93.65%), urine red blood cells increased in49cases (77.78%). the patients were admitted first days appears urine routinechange.Biochemical indexes: CK-MB increased in34cases (53.97%), Cr increase in42cases (66.67%), ALT increased in48cases (76.19%), AST increased in50cases(79.37%), TB (49cases,77.78%), DB (47,74,60%), IB (54cases,85.71%) also have varying degrees of increase; Arterial blood gas index: PaO2decreased in45cases(71.43%), PaCO2decreased in53cases (84.13%), of which47cases (74.60%) in firstdays in the hospital that decreased PaCO2.PH decreased in25cases (39.68%), PHincreased in12cases (19.05%); D-two dimer: the two D-dimer was detected in30cases of PQP patients, of which20cases (66.67%) was higher than that of the normal.Changes of pulmonary imaging:4cases from16cases of mild poisoning patients arewithout pulmonary imaging changes and12cases appeared different degree Increasedlung markings, disorder in3~6days.33cases of severe poisoning, a ground-glassopacity:20patients appears increased lung markings and disorder on admission dayand3~4days later multiple patchy shadows of high density appears, with blurededge.And also shows cord-like shadows of high density.13cases are out of lungimaging changes on the day of admission, admission3~6days increased lungmarkings disorder, presenting ground-glass change or patchy shadows of high density.the CT appears pulmonary fibrosis in15cases which was redetected after2weeks in thehospital;14cases of fulminant PQP patients admitted to the initial visible double lungmultiple patchy, cord-like or the mesh density shadow, with the blurred edge. Pleuraleffusion in6cases (9.52%),4cases of pneumothorax (6.35%),2cases of mediastinalemphysema (3.17%). The factors related to prognosis: single factor analysis showed between the death group and the survival group, the difference was statisticallysignificant (P<0.05) in age, dose, PH, PCO2, Lac, ALT, TB, CK, Cr.The multiple linearregression analysis showed that the toxic dose, PCO2, Lac are in the higher reliability tothe prognosis of (P<0.05).Conclusion: Clinical symptoms of PQP are complicated, which can lead tomultiple organ system damage, including lung, heart, liver, kidney, blood system andthe digestive system; lung is the main target organ of PQP, mainly for the chest pain,dyspnea and pulmonary imaging changes, for the further development of type Irespiratory failure; lung lesions appear sooner, the greater range, prognosis is poorer;kidney is one of the most commonly involved organs early, some patients developedacute renal failure, mainly for the non oliguric acute renal failure; toxic dose, PCO2,Lac can be used as a reference index to estimate the prognosis of acute PQP. |
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