不同进食时间对急性百草枯中毒患者预后的影响

发布时间：2018-02-11 14:31

本文关键词： 百草枯中毒预后进食时间急性肺损伤肺纤维化　出处：《河北医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:对沧州市人民医院自2009年1月至2013年9月收治的254例急性百草枯中毒患者进行回顾性分析,了解不同时间进食对患者的并发症及预后情况是否有影响,为该病患者的合理进食时间提供科学依据,提升救治成功率。方法:回顾性收集2009年1月至2013年9月就诊于沧州市人民医院急诊科254例急性百草枯中毒患者的病例资料,按照病情轻重将纳入研究的患者分成3组,轻型53例,中-重型72例,爆发型129例,对每组患者按照不同的进食时间分成6个时间段,统计分析不同进食时间患者的并发症及预后情况,包括急性肺损伤/肺纤维化、急性肾损伤、急性肝损伤、存活情况。结果:对纳入研究的254例患者进行统计学分析,不同进食时间对各种并发症及预后的影响均无统计学意义(P0.05)。但进一步分型后发现,轻型患者共53例,不同进食时间对存活率的影响,P0.01,有统计学意义;其中在12小时时间段进食的患者存活率最低(80.00%),44小时时间段进食的存活率最高(100.00%);进食时间对并发急性肺损伤/肺纤维化、急性肾损伤、急性肝损伤的影响无统计学意义(P0.05)。中-重型患者共72例,不同进食时间对存活率、急性肺损伤/肺纤维化、急性肾损伤的影响,P0.01,有统计学意义;在12、13-20小时时间段进食的患者存活率最低(50.00%),44小时时间段进食的存活率最高(71.43%);在44小时时间段进食的患者并发急性肺损伤/肺纤维化的发生率最低(28.57%),在13-20小时时间段进食的发生率最高(60.00%);在12小时时间段进食的患者并发急性肾损伤的发生率最低(33.33%),37-43小时时间段进食的发生率最高(57.14);不同进食时间对发生急性肝损伤的影响无统计学意义(P0.05)。爆发型患者共129例,不同进食时间对发生急性肺损伤/肺纤维化、急性肾损伤、急性肝损伤的影响,P0.01,有统计学意义;进食时间越晚的患者预后相对越好,其中在44小时时间段进食的患者并发急性肺损伤/肺纤维化、急性肾损伤、急性肝损伤的发生率最低(分别为74.07%、74.07%、40.74%、66.67%),在12、13-20小时时间段进食的患者并发急性肺损伤/肺纤维化、急性肾损伤的发生率最高(100.00%);12小时时间段进食的患者并发急性肝损伤的发生率最高(100.00%);进食时间对存活率的影响无统计学意义(P0.05)。急性百草枯中毒不同进食时间对出现脏器损伤可能存在影响,治疗过程中应根据服毒量及时近一步分型,区分轻重程度,选择合适的进食时间,有可能改善预后。结论:1急性百草枯中毒总体病死率高,与服毒量相关,爆发型预后不良,中-重型次之,轻型较好。2急性百草枯中毒不同进食时间对出现脏器损伤可能存在影响,治疗过程中应根据服毒量及时近一步分型,区分轻重程度,选择合适的进食时间,有可能改善预后。3急性百草枯中毒患者合适的进食时间尚需探讨。
[Abstract]:Objective: to analyze retrospectively 254 patients with acute paraquat poisoning admitted to Cangzhou people's Hospital from January 2009 to September 2013 to understand whether eating food at different times has influence on the complications and prognosis of the patients. Methods: from January 2009 to September 2013, 254 cases of acute paraquat poisoning in emergency department of Cangzhou people's Hospital were collected retrospectively. According to the severity of the disease, the patients in the study were divided into three groups: 53 mild, 72 moderate and 129 fulminant. Each group was divided into 6 time periods according to different feeding time. The complications and prognosis of patients with different feeding time were statistically analyzed, including acute lung injury / pulmonary fibrosis, acute renal injury, acute liver injury and survival. The influence of different feeding time on the complications and prognosis was not statistically significant (P 0.05). However, 53 cases of mild patients were found after further classification, and the effect of different feeding time on the survival rate was significant (P 0.01). Among them, the survival rate of the patients who ate at 12 hours was the lowest (80.00000) and the survival rate was the highest at the time of 44 hours (100.000. 00g). The time of eating was associated with acute lung injury / pulmonary fibrosis and acute renal injury. There was no significant difference in the effect of acute liver injury on the survival rate, acute lung injury / pulmonary fibrosis and acute renal injury in 72 patients with moderate to severe liver injury (P 0.01). The survival rate of patients with acute lung injury / pulmonary fibrosis was the lowest in patients who took food at 120.13-20 hours and the highest survival rate was 71.43in 44 hours, and 28.5775 in patients with acute lung injury / pulmonary fibrosis during the period of 13-20 hours. The survival rate of patients with acute lung injury / pulmonary fibrosis was lower than that of patients with acute lung injury / pulmonary fibrosis in the period of 12-20 hours. The incidence of food intake was the highest (60.00g / kg); the incidence of acute renal injury was the lowest in patients who ate at 12 hours (33.33 / 37-43 hours); the incidence of acute liver injury was not significantly affected by different feeding time (57.14g / kg). There were 129 cases of outbreak type. The effect of different feeding time on the occurrence of acute lung injury / pulmonary fibrosis, acute renal injury and acute liver injury was statistically significant. The incidence of acute lung injury / pulmonary fibrosis, acute renal injury, and acute liver injury were the lowest in patients who ate at 44 hours (74.07, 74.07 and 40.74, 66.67, respectively), and those who ate at 1213-20 hours were complicated with acute lung injury / pulmonary fibrosis. The incidence of acute renal injury was the highest in the patients who ate at 100.00000 hours and had the highest incidence of acute liver injury. The effect of feeding time on survival rate was not statistically significant (P 0.05). Different feeding time of acute paraquat poisoning had significant effect on the occurrence of acute liver injury. Organ damage may have an effect, In the course of treatment, the prognosis may be improved according to the level of toxicity and the appropriate feeding time. Conclusion the overall fatality rate of acute paraquat poisoning at 1: 1 is high, which is related to the amount of poison taken, and the prognosis of outbreak type is poor. Mild paraquat poisoning with different feeding time may have an effect on visceral injury. In the course of treatment, it is necessary to select the appropriate feeding time according to the level of toxicity and the degree of severity. It is possible to improve the prognosis of 3. 3 patients with acute paraquat poisoning the appropriate feeding time needs to be explored.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R595.4

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