The Treatment And Prognosis Analysis Of Paraquat Poisoning

Objective: Paraquat is a kind of organic heterocyclic contact insecticide,which has low-toxicity to environment but is supervirulent to human beingsand animals. With the widely use of paraquat, the poisoning incidents causedby paraquat is growing and with high fatality, of which the harm has farexceeded poisoning caused by other drugs such as organophosphorus, andhave become a common severe case in emergency department. However, thereis still no specific treatment for paraquat poisoning, and it is also hard tocriteria whether a treatment has advantage or not. In this article, we will dosome research about the prognostic significance of comprehensive therapeuticplan for paraquat poisoning by analyzing the clinical data of180cases ofpatients with paraquat poisoning in our hospital emergency to provide basisfor clinical treatment and predicting prognosis in early stage in order toexplore more effective treatments.Methods:180clinical cases of paraquat poisoning are collected in theSecond Hospital of Hebei Medical University between June2010and June2012. a statistical analysis about their age, amount of poison, the poison testconcentration, the time from taking poison to gastric, to catharsis and to bloodpurification, the time of blood purification, the dosage ofMethylprednisolone, Cyclophosphamide, Ulinastatin and Xuebijing used. Wedivided the patients into survival group (n=106) and death group (n=74)according to the different prognosis. Then, we compared and analyzed thedifference of above indexes between two groups by two independent samplesindependent nonparametric tests (Mann-Whitney U test). Binary backwardsstepwise logistic regression analysis is made with the dependent variable ofprognosis and independent variable of other related indicators to find therelationship between prognosis and other indicators (αin=0.10,αout=0.05). Andthen, the logistic regression analysis based on the oral dose stratification (0~20ml for mild,20~40ml for moderate and≧40ml for severe) is made tofind the degree of association between the prognosis and the time of bloodpurification, the dosage ofMethylprednisolone, Cyclophosphamide,Ulinastatin and Xuebijing.Results: Among the180cases, there were106survivals and74deaths,and the mortality rate was41.1%. The non-parametric rank and tests of twoindependent samples shows the significant difference between differentgroups(all, P <0.01). The result of logistic regression analysis showed that thetime from taking poison to gastric, to catharsis and to blood purification, thedosage of Methylprednisolone, Ulinastatin and Xuebijing had no statisticallysignificant in effect on prognosis (all, P>0.05). The amount of poison, poisontest concentration, the time of blood purification, the dosage ofCyclophosphamide were factors of prognosis(all, P <0.05), of which the ORvalue and95%CI were5.257（2.722~10.151）,5.661（2.082~15.396）,0.682（0.506~0.920）and0.186（0.073~0.476）respectively. A number of67caseswere mild with60survivals,7deaths and mortality rate10.4%. The time ofblood purification, the dosage of Methylprednisolone, Ulinastatin andXuebijing had no statistically significant influence on prognosis (all, P>0.05).There were28survivals and11deaths with mortality rate of28.2%in39cases of moderate patients. The dosage of Methylprednisolone, Ulinastatin andXuebijing had no statistically significant influence on prognosis (all, P>0.05)and the time of blood purification was the only risk factors of the effect onprognosis with OR value and95%CI of0.651（0.431~0.983）. For the74severe patients, there were18survivals and56deaths, and the mortality ratewas75.7%. The time of blood purification, the dosage of Methylprednisoloneand Xuebijing had no statistically significant influence on prognosis(all, P>0.05), and the dosage of Ulinastatin became the independent riskfactors(P<0.05) with OR value and95%CI of0.151（0.041~0.562）.Conclusions: Paraquat poisoning has high mortality rate. The amount ofpoison, poison test concentration, the dosage of Ulinastatin are correlativefactor of the prognosis of patients with paraquat poisoning. The study shows that the times of blood purification is independently associated with prognosisof moderate patients and the dosage of Ulinastatin is independently associatedwith that of severe patients except the amount of poison which is aconfounding factor based on the oral dose stratification (Mild0~20ml,moderate20~40ml and severe≧40ml).