Huang Neng Chyan, Lin Shoa Lin, Hung Yao Min, Hung Shin Yuan, Chung Hsiao Min
Division of Nephrology, Intensive Care Unit, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
J Formos Med Assoc. 2003 Nov;102(11):782-7.
Several methods have been proposed to predict prognosis in patients with paraquat poisoning, but all have their limitations. This retrospective study evaluated the usefulness of Acute Physiology and Chronic Health Evaluation (APACHE) II scores in risk stratification for patients with paraquat poisoning.
Data from 58 adults with a diagnosis of paraquat poisoning presenting to a general hospital over a 10-year period were analyzed. APACHE II scores were calculated at 24 hours after admission and data on related parameters during the first 24 hours were collected for study.
The overall in-hospital mortality was 72.4% and mortality in the intensive care unit was 82.2%. APACHE II scores were higher in non-survivors (n = 42, 23.3 +/- 12.4) than in survivors (n = 16, 6.7 +/- 4.1; p < 0.001). All 26 patients (44.8%) who received mechanical ventilation died. Of the 32 patients who received hemoperfusion, 25 (78.1%) died. Plasma paraquat concentration, estimated ingested amount of paraquat, and APACHE II score were significantly higher in non-survivors than in survivors (p < 0.05 for all comparisons). There were significant correlations between APACHE II score and the following variables: plasma paraquat concentration, estimated ingested amount of paraquat, and the peak values during the first 24 hours after admission for fraction of inspired oxygen, alveolar-arterial oxygen gradient, aspartate aminotransferase, alanine aminotransferase, blood urea nitrogen, and serum creatinine (p < 0.05 for all comparisons). Higher APACHE II score was associated with greater mortality. All patients who had an APACHE II score greater than 20 died before discharge.
This study has demonstrated that the APACHE II score is positively correlated with plasma paraquat concentration and ingested amount of paraquat. An APACHE II score of 20 or higher is a good predictor of in-hospital mortality.
已提出多种方法来预测百草枯中毒患者的预后，但均有其局限性。本回顾性研究评估急性生理学与慢性健康状况评估（APACHE）II评分在百草枯中毒患者风险分层中的作用。
分析了10年间某综合医院收治的58例诊断为百草枯中毒的成年患者的数据。入院24小时后计算APACHE II评分，并收集入院后最初24小时内相关参数的数据进行研究。
总体院内死亡率为72.4%，重症监护病房死亡率为82.2%。非存活者（n = 42，23.3±12.4）的APACHE II评分高于存活者（n = 16，6.7±4.1；p < 0.001）。所有接受机械通气的26例患者（44.8%）均死亡。在接受血液灌流的32例患者中，25例（78.1%）死亡。非存活者的血浆百草枯浓度、估计百草枯摄入量和APACHE II评分显著高于存活者（所有比较p < 0.05）。APACHE II评分与以下变量之间存在显著相关性：血浆百草枯浓度、估计百草枯摄入量以及入院后最初24小时内的吸入氧分数、肺泡-动脉氧分压差、天冬氨酸转氨酶、丙氨酸转氨酶、血尿素氮和血清肌酐的峰值（所有比较p < 0.05）。较高的APACHE II评分与更高的死亡率相关。所有APACHE II评分大于20的患者均在出院前死亡。
本研究表明，APACHE II评分与血浆百草枯浓度和百草枯摄入量呈正相关。APACHE II评分20分或更高是院内死亡率的良好预测指标。
