Lee Eun-Young, Hwang Kyu-Yoon, Yang Jong-Oh, Hong Sae-Yong
Department of Internal Medicine, College of Medicine, Soonchunhyang University, Chonan, Chungnam, Korea.
Toxicol Ind Health. 2002 May;18(4):201-6. doi: 10.1191/0748233702th141oa.
Acute paraquat poisoning is often fatal. Many studies have investigated successful treatment modalities, but no standard treatment yet exists. The purpose of this study was to determine the predictors of survival after acute paraquat poisoning in 602 patients. The paraquat exposure was assessed based on the amount of ingested paraquat and a semiquantitative measure of the urine level of paraquat. Initial clinical parameters including vital signs, hemoglobin, white-blood-cell count, pH, PaCO2, PaO2, blood urea nitrogen, creatinine, aspartate aminotransferase, alanine aminotransferase, total bilirubin, amylase, and glucose were obtained at the time of arrival at the emergency room. Outcomes after acute paraquat poisoning were categorized as survivors and nonsurvivors. Multiple logistic regression analysis was applied to assess the predictors of survival after acute paraquat poisoning. Some patients (55.5%) survived after oral ingestion of paraquat, whereas all those exposed to paraquat percutaneous or inhalational route survived. The amount of paraquat (24.5% concentrate of 1,1'-dimethyl-4,4'-bipyridium dichloride) ingested was 45.6 +/- 74.1 mL (mean +/- SD). In addition to degree of paraquat exposure, survival after acute paraquat poisoning was associated with age, respiratory rate, pH, PaCO2, hemoglobin, white-blood-cell count, blood urea nitrogen, amylase, and the number of failed organs in multiple logistic regression analysis. In conclusion, young age, percutaneous or inhalational route, exposure to less paraquat, and lesser degrees of leukocytosis, acidosis, and renal, hepatic, and pancreatic failures on admission are good prognostic factors of survival after acute paraquat poisoning.
急性百草枯中毒往往是致命的。许多研究已经对成功的治疗方式进行了调查，但目前尚无标准治疗方法。本研究的目的是确定602例急性百草枯中毒患者的生存预测因素。根据摄入的百草枯量和尿液中百草枯水平的半定量测量来评估百草枯暴露情况。在患者到达急诊室时获取初始临床参数，包括生命体征、血红蛋白、白细胞计数、pH值、动脉血二氧化碳分压（PaCO2）、动脉血氧分压（PaO2）、血尿素氮、肌酐、天门冬氨酸氨基转移酶、丙氨酸氨基转移酶、总胆红素、淀粉酶和葡萄糖。急性百草枯中毒后的结局分为幸存者和非幸存者。应用多因素logistic回归分析来评估急性百草枯中毒后生存的预测因素。一些经口服摄入百草枯的患者（55.5%）存活，而所有经皮肤或吸入途径接触百草枯的患者均存活。摄入的百草枯（1,1'-二甲基-4,4'-联吡啶二氯化物24.5%浓缩液）量为45.6±74.1 mL（平均值±标准差）。在多因素logistic回归分析中，除了百草枯暴露程度外，急性百草枯中毒后的生存还与年龄、呼吸频率、pH值、PaCO2、血红蛋白、白细胞计数、血尿素氮、淀粉酶以及入院时衰竭器官的数量有关。总之，年龄较小、经皮肤或吸入途径接触、接触的百草枯较少以及入院时白细胞增多、酸中毒以及肾、肝和胰腺功能衰竭程度较轻是急性百草枯中毒后生存的良好预后因素。
