Zhang Minghao, Zhao Shunzhong, Sun Mingji, Zhang Wei, Wang Boliang
Department of Internal Medicine, The 63710 Force Hospital of Chinese People's Liberation Army, Xinzhou, China.
Department of Emergency, The Second Affiliated Hospital, Air Force Military Medical University, Xi'an, China.
J Res Med Sci. 2024 Jul 12;29:34. doi: 10.4103/jrms.jrms_442_22. eCollection 2024.
Paraquat poisoning remains a critical public health issue with no established effective treatment. Hemoperfusion (HP) has been recognized for its potential to remove toxins and is widely employed in several developing countries for managing acute paraquat poisoning cases. However, the reluctance of some patients to undergo this recommended treatment has been observed but not thoroughly investigated. This study aimed to explore the factors associated with the refusal of HP in patients suffering from paraquat intoxication.
In this retrospective study, data of 358 patients with acute paraquat poisoning were analyzed in Xi'an, China. The outcome of our study was mortality, and the influential factors were age, gender, marital status, educational level, symptoms at presentation, and laboratory findings. A logistic regression model was utilized to explore the independent risk factors.
In a total of 358 paraquat-poisoned patients, the significant differences were found between patients who underwent HP and those who did not, particularly regarding mean age (48.02 years vs. 42.32 years; = 0.01), mental disorders (15.6% vs. 6.1%; = 0.01), poisoning severity score (2.36 vs. 2.57; = 0.03), organ failure (10.9% vs. 23.5%; = 0.02), and mechanical ventilation (18.8% vs. 33.3%; = 0.02). Patients who refused HP exhibited a higher mortality (20.3% vs. 10.9%; = 0.03) compared to those who received HP. Age (odds ratio (OR), 1.76; 95% confidence interval (CI): 1.01-3.82; = 0.01) and history of mental disorders (OR, 2.81; 95% CI: 1.19-6.61; = 0.02) were identified as significant independent predictors for the refusal of HP.
The results of this study showed that elderly individuals and those with a history of mental disorders were independently associated with refusing HP in patients with acute paraquat poisoning.
百草枯中毒仍然是一个严峻的公共卫生问题，尚无已确立的有效治疗方法。血液灌流（HP）因其具有清除毒素的潜力而得到认可，并在一些发展中国家广泛用于处理急性百草枯中毒病例。然而，已观察到一些患者不愿接受这种推荐的治疗方法，但尚未进行深入调查。本研究旨在探讨与百草枯中毒患者拒绝血液灌流相关的因素。
在这项回顾性研究中，对中国西安358例急性百草枯中毒患者的数据进行了分析。本研究的结局指标是死亡率，影响因素包括年龄、性别、婚姻状况、教育程度、就诊时的症状以及实验室检查结果。采用逻辑回归模型来探究独立危险因素。
在总共358例百草枯中毒患者中，接受血液灌流和未接受血液灌流的患者之间存在显著差异，特别是在平均年龄（48.02岁对42.32岁；P = 0.01）、精神障碍（15.6%对6.1%；P = 0.01）、中毒严重程度评分（2.36对2.57；P = 0.03）、器官衰竭（10.9%对23.5%；P = 0.02）以及机械通气（18.8%对33.3%；P = 0.02）方面。与接受血液灌流的患者相比，拒绝血液灌流的患者死亡率更高（20.3%对10.9%；P = 0.03）。年龄（比值比（OR），1.76；95%置信区间（CI）：1.01 - 3.82；P = 0.01）和精神障碍病史（OR，2.81；95%CI：1.19 - 6.61；P = 0.02）被确定为拒绝血液灌流的显著独立预测因素。
本研究结果表明，在急性百草枯中毒患者中，老年人和有精神障碍病史的人独立地与拒绝血液灌流相关。
