| Objective: Currently most researches are concentrating on the treatment of paraquat poisoning, while the researches on the early prognostic indicators are rare. Early prognostic indicators not only have great values for early diagnosis and intervention, but also have an important significance in judgment of disease development and determination of treatment scheme. Through the correlation analysis on oral dose of patients with acute paraquat poisoning, early blood drug concentration, the worst APACHEⅡscores in 24 hours, the worst Sorensen scale(PH value) in 24 hours, the worst bicarbonate ions(HCO3-) in 24 hours, the worst white blood cells count(WBC) in 24 hours, the worst blood potassium(K+) in 24 hours, the worst serum creatinine(CR) in 24 hours and the prognosis of paraquat poisoning, the study can provide a reference for clinicians to assess the severity of the disease, decide prognosis and determine the treatment plan.Methods: We collected patients diagnosis with acute paraquat poisoning from 2009 January to 2013 August, and selected oral poisoned patients whose blood preparations were took at the time of time of admission to hospital and sent to Beijing 307 toxicology testing center, by using the LC- 20 AT type high performance liquid chromatograph of Shimadzu Corporation, and with a SPD-M20 A diode array detector, we made the sampling by hand, there were 123 patients tested positive in paraquat concentration in blood test. All patients were retrospectively analyzed, and they were divided into survival group 46 cases and death group 77 cases, male 60 cases, female 63 cases. We also analyzed the relationship among the oral doses, paraquat concentrations in blood at the time of admission, time lags from the first time gastric lavage to poisoning, time lags from the first time blood perfusion to poisoning, the worst APACHEⅡscores in 24 hours, the worst sorensen scales(PH value) in 24 hours, the worst bicarbonate ions(HCO3-) in 24 hours, the worst white blood cells count(WBC) in 24 hours, the worst blood potassium(K+) in 24 hours, the worst serum creatinine(CR) in 24 hours and prognosis of two groups of patients.Statistical method: SPSS19.0 statistical software was adopted, the measurement data in line with the normal distribution were indicated with x ±s, the two two comparison was tested with t or t’, those measurement data that did not meet the normal distribution were indicated with median( range interquartile) [M(Q)], tested by non parametric Mann-Whithey U. Comparisons among enumeration data groups were tested with chi square, and Logistic forward stepwise regression analysis was adopted to screen out the most valuable indexes. ROC curve was established for the most valuable indexes, to evaluate the prognostic significance of these indexes to death, P<0.05 meant there was statistical significance, diagnostic value of these indexes in prognosis of paraquat poisoning was evaluated through ROC curve.Results: We collected 249 cases of diagnosis with acute paraquat poisoning from 2009 January to 2013 August in Cangzhou People’s Hospital. Among it there were 210 cases of oral poisoning, accounting for 94.78%, and 13 cases with skin contact pesticide spraying, accounting for 5.22%. Among the oral poisoning patients there were 24 cases gave up treatment and we failed to follow up to know whether they survived or not due to changes of phone numbers. There were 212 cases of oral poisoned patients followed up, among which 135 cases dead, and 77 cases survived(telephone follow-up + outpatient visits, to determine that the patients do not have obvious discomfort after discharged from hospital and live a normal life more than 3 months), the death rate was 63.68%. 123 cases had the blood preparations at the time of admission and positive results of paraquat concentrations in blood tested by Beijing 307 toxicology testing center and auxiliary examination results of complete blood gas analysis within 24 hours after admission, routine blood test, biochemistry, ions and so on. There was no significant difference in the proportion of male and female in these 123 patients(1:1.05); Most poisoned patients were aged between 20-29(40.65%), followed by those aged 30-39(21.13%), high incidence ages were 20-39(61.78%). Before the age of 39 no significant difference was found in the proportion of male and female, between 40-49 there were more female than male, and between 50-59 there were more male than female. The number of agricultural population accounted for 96.75%, while the number of urban households accounted for 3.25%. Those poisoned patients were mainly with junior high school diploma and below, accounting for 91.06 %; the highest cultural degree of the poisoned patients was post graduate student, there was one, accounted for 0.8%. The oral doses, paraquat concentrations in blood at the time of admission, the worst APACHEⅡscores in 24 hours, the worst white blood cells count(WBC) in 24 hours, and the worst serum creatinine(CR) in 24 hours of the death group was significantly higher than those of the survival group, and there was statistical significance in differences(P<0.01). While the worst Sorensen scale(PH value) in 24 hours, the worst bicarbonate ions(HCO3-) in 24 hours,and the worst blood potassium(K+) in 24 hours of the death group was significantly lower than those of the survival group, and there was statistical significance in differences(P<0.01). Through the Logistic forward stepwise analysis, the worst APACHE scores in 24 hours entered into the Logistic regression equation, which had a significant impact on the risk assessment of mortality in patients. By analyzing the area under the ROC curve of the worst APACHEⅡscores in 24 hours, the area was 0.992, the specificity was 0.961, and the sensitivity was 0.957.Conclusions:1 Oral dose, paraquat concentrations in blood at the time of admission, the worst APACHEⅡscores in 24 hours, the worst sorensen scale(PH value) in 24 hours, the worst bicarbonate ions(HCO3-) in 24 hours, the worst white blood cells count(WBC) in 24 hours, the worst blood potassium(K+) in 24 hours, and the worst serum creatinine(CR) in 24 hours can all be used as indicators in the evaluation of severity of acute paraquat poisoning.2 There are correlations among the worst values in 24 hours, sorensen scale(PH value), bicarbonate ion(HCO3-), white blood cells count(WBC), blood potassium(K+), serum creatinine(CR) and oral dose, paraquat concentrations in blood at the time of admission, and the worst APACHEⅡscores in 24 hours, blood drug concentration, and the correlation with the worst APACHEⅡscores in 24 hours is closer.3 APACHEⅡscores in 24 hours is a reliable indicator in early prediction of the prognosis of patients with acute paraquat poisoning. |
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