| ObjectiveThe dynamic monitoring of blood paraquat concentration and laboratory test data in 73 patients with acute paraquat poisoning was conducted to explore the relationship between the dynamic changes of blood paraquat concentration and the related laboratory examination data and the prognosis.Methods73 cases of paraquat poisoning from January 1,2017 to December 31,2017 in Qilu Hospital of Shandong University were retrospectively analyzed.The patients were divided into survival group and death group.The patients were divided into 4 groups:low concentration group,medium concentration group,high concentration group and higher concentration group with the first serum paraquat concentration.The age,sex,time from taking poison to admission were recorded.The blood paraquat concentration at admission 1,2,3 and 4 days,and the laboratory test data at 1,3 and 7 days after admission were recorded.To study the value of these factors on the progression and prognosis of patients with acute paraquat poisoning and to compare the differences in the survival rate and laboratory test data of patients with different initial drug concentrations.Results1.Compared the blood drug concentration in the survival group and the death group:the median of the primary blood concentration in the survival group was 0.355 jig/ml,the median of the primary blood paraquat concentration in the death group was 2.959μg/ml,the concentration of the blood drug in the survival group was lower than that of the death group.2.Compared the laboratory test data at different time between the survival group and the death group:the WBC and NEU in the death group were significantly higher than those in the survival group;the liver and kidney function,the creatine kinase isozyme and the pancreatic enzyme in the death group were significantly higher.The blood potassium level of the group was lower than that of the survival group on the first,third day after admission,and the initial pH of the death group was significantly lower than that of the survival group,while the lactic acid value was significantly higher than that of the survival group.3.Logistic regression analysis showed that,NEU,pH,Lac at first day after admission,and Cr and BUN at third day of admission were closely related to prognosis.4.The risk factors that the area under the ROC curve was over 0.9 were the concentration of paraquat and Lac.The area under the ROC curve of the initial blood concentration was 0.973,p<0.01,threshold 1.033,sensitivity 0.964,specificity 0.911,and the best Jordan index was 0.875.The area under the ROC curve of Lac is 0.922,p<0.01,threshold is 5.05,sensitivity is 0.786,specificity is 0.978,and the best Jordan index is 0,763.The risk factors that the area under the ROC curve is between 0.7 and 0.9 were WBC,NEU,AST,Cr,CK-MB,LPS.The area under the curve is 0.803,0.816,0.790,0.718,0.751,0.702,and p<0.05.5.Compare the survival rate and survival time of different drug concentration groups(survival patients were followed up for 3 months,survival time was 90d).With 18 cases of low concentration group(primary paraquat concentration<0.309 g/ml),18 living cases and the survival rate was 100%.With 18 cases of medium concentration group(primary blood paraquat concentration of 0.309-0.659μg/ml),17 cases were survived,and the survival rate was 94.4%;In high concentration group(primary blood paraquat concentration of 0.659-3.525μg/ml),the survival rate was 52.6%;In the higher concentration group(primary paraquat concentration>3.525μg/ml),there were 18 cases,the survival case was 0,the survival rate was 0%;the total survival rate was 61.6%.The survival rates of the 4 groups were low concentration group>medium concentration group>high concentration group>higher concentration group.The median survival time in the low concentration group was 90d,the median survival time was 90d,the median survival time in the high concentration group was 37d,and the median survival time of the higher concentration group was 2d.6.The difference in the laboratory test data of different drug concentration groups at different time points:At first day in the hospital,PH,Lac,WBC,NEU,AST,Cr,CK-MB,LPS in the low concentration group,the medium concentration group and the high concentration group.On the seventh day of admission,ALT,AST,Cr,BUN,CK-MB,LPS and AMS were significantly different in the 3 groups.Conclusions1.NEU,pH,Lac,Cr and BUN were closely related to the prognosis of patients with acute paraquat poisoning.In addition,the blood paraquat concentration and Lac were the ideal indicators to predict the death of patients with acute paraquat poisoning.2.the higher the concentration of paraquat in the first time,the lower the survival rate and the shorter the median survival time.3.the WBC,NEU,AST,Cr,CK-MB and LPS at different time points in the patients with different concentration of paraquat were different,which could be used as a reference to the advance of the disease. |
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