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目的:回顾性研究急性百草枯(Paraquat,PQ)中毒患者的肝脏酶谱变化,评价急性PQ中毒的危险因素及预后。方法:回顾性分析我院近6年收治的急性PQ中毒患者,按照ALT是否达到正常上限3倍以上分为急性肝损伤组和非肝损伤组,分析评价患者的一般情况、生化及动脉血气分析数据等,同时也分析急性肝损伤危险因素、2组的生存率差异等。结果:共320例急性PQ中毒患者入选本研究,其中134例发生急性肝损伤,占41.9%,急性肝损伤发生的平均时间为(3.6±1.3)d,ALT平均为413(IQR,227.8~614.3)U/L,其中最高值为4 040U/L。急性肝损伤组与非肝损伤组比较,2组患者在口服量[(73.0±58.2)ml vs.(41.8±42.0)ml,P<0.01)]、血PQ浓度[(2.0±1.8)μg/ml vs.(0.7±1.1)μg/ml,P<0.01)],就诊时间[(6.1±3.4)h vs.(5.2±3.1)h,P=0.015)]差异有统计学意义,急性肝损伤组患者肾损伤发生率、低氧血症发生率及胰腺损伤发生率均明显高于非肝损伤组(81.3%vs.36.6%,P<0.01;65.7%vs.22.0%,P<0.01;32.8%vs.4.3%,P<0.01),2组患者死亡率差异有统计学意义(78.4%vs.18.8%,P<0.01),急性肝损伤是急性PQ中毒的死亡危险因素之一(HR=1.921,95%CI1.011~3.649,P=0.046)。结论:急性肝损伤是急性PQ中毒的常见并发症,也是急性PQ中毒的死亡危险因素,总之,急性PQ中毒导致急性肝损伤一般出现在1周内,且多较严重。
Objective: To retrospectively study the changes of hepatic zymogram in patients with acute paraquat (PQ) poisoning and to evaluate the risk factors and prognosis of acute PQ poisoning. Methods: A retrospective analysis of our hospital in the past 6 years of acute PQ poisoning patients, according to whether the ALT reached more than three times the upper limit of normal was divided into acute liver injury group and non-liver injury group, analysis and evaluation of the general situation of patients, biochemical and arterial blood gas analysis Data, etc., but also analysis of risk factors for acute liver injury, two groups of differences in survival rates. Results: A total of 320 patients with acute PQ poisoning were enrolled in this study. Among them, 134 patients had acute liver injury (41.9%), the average duration of acute liver injury was (3.6 ± 1.3) d, and the mean ALT was 413 (IQR, 227.8 ~ 614.3 ) U / L, the highest value of which is 4040U / L. The levels of PQ in the two groups were significantly higher than those in the non-hepatic injury group [(73.0 ± 58.2) ml vs. (41.8 ± 42.0) ml, P <0.01) ml vs. (0.7 ± 1.1) μg / ml, P <0.01). The time to visit was (6.1 ± 3.4) h vs. (5.2 ± 3.1) h, P = 0.015). There was a statistically significant difference in acute liver injury The incidence of kidney injury, hypoxemia and the incidence of pancreatic injury were significantly higher in the patients than in the non-liver injury patients (81.3% vs.36.6%, P <0.01; 65.7% vs.22.0%, P <0.01; 32.8 % vs.4.3%, P <0.01). The mortality of two groups of patients was significantly different (78.4% vs.18.8%, P <0.01). Acute liver injury was one of the risk factors of death in acute PQ poisoning (HR = 1.921, 95% CI 1.011-3.649, P = 0.046). Conclusion: Acute liver injury is a common complication of acute PQ poisoning and also a risk factor for death from acute PQ poisoning. In conclusion, acute liver injury caused by acute PQ poisoning usually occurs within one week and is more severe.