中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2011年
8期
845-850
,共6页
李昌斌%李新华%王贞%姜成华%彭艾
李昌斌%李新華%王貞%薑成華%彭艾
리창빈%리신화%왕정%강성화%팽애
分光光度法%导数分光光度法%百草枯%中毒%血清%质量浓度%检测%临床意义
分光光度法%導數分光光度法%百草枯%中毒%血清%質量濃度%檢測%臨床意義
분광광도법%도수분광광도법%백초고%중독%혈청%질량농도%검측%림상의의
Spectrometry%Derivative spectrometry%Paraquat%Poisoning%Serum%Concentration%Determination%Clinical significance
目的 评价分光光度法测定血清百草枯(paraquat，PQ)质量浓度的可靠性及其临床意义。方法 验证普通分光光度法和二阶导数分光光度法测定血清PQ质量浓度的检测波长后，采用二阶导数分光光度法测定血清PQ质量浓度，确定其线性范围并评价其准确性；采用该法测定8例PQ中毒患者血清PQ质量浓度并与高效液相色谱法测定值比较分析其可靠性；对上海市第十人民医院肾病免疫科2008年10月至2010年9月收治的口服PQ4h以上人院的21例急性PQ中毒患者的资料行回顾性统计分析，根据该法测定患者入院时血清PQ质量浓度是否大于1.8 μ.g/mL分为两组，采用成组t检验和Fisher精确概率法对两组患者的临床特征进行统计分析。结果 (1)普通分光光度法检测含PQ血清样本时在257 nm波长处未见明显吸收峰；(2)二阶导数分光光度法测定血清PQ质量浓度在0.4～8.0 μg/mL范围内呈现良好的线性关系，相关系数为0.996；回收率为95.0％～99.5％，相对标准差(RSD)为1.35％～5.41％ (n=6)，检出下限为0.05 μg/mL;(3)8例PQ中毒患者血清PQ质量浓度二阶导数分光光度法测定值与HPLC法检测值相吻合，r=0.995，P＜0.01；(4)血清PQ质量浓度＞1.8 μg/mL组患者存活率为22.2％，酸中毒和少尿发生率55.6％，纵膈气肿发生率77.8％，与血清PQ质量浓度＜1.8 μg/mL组比较差异均有统计学意义(P＜0.05)。结论 (1)普通分光光度法用于测定血清PQ质量浓度不能采用257 rn为检测波长；(2)二阶导数分光光度法用于检测血清百草枯质量浓度可靠性高；(3)二阶导数分光光度法测定值可用于中毒患者的临床严重程度判断，口服PQ中毒4h后血清质量浓度＞1.8 μg/mL是患者预后不良的重要指标。
目的 評價分光光度法測定血清百草枯(paraquat，PQ)質量濃度的可靠性及其臨床意義。方法 驗證普通分光光度法和二階導數分光光度法測定血清PQ質量濃度的檢測波長後，採用二階導數分光光度法測定血清PQ質量濃度，確定其線性範圍併評價其準確性；採用該法測定8例PQ中毒患者血清PQ質量濃度併與高效液相色譜法測定值比較分析其可靠性；對上海市第十人民醫院腎病免疫科2008年10月至2010年9月收治的口服PQ4h以上人院的21例急性PQ中毒患者的資料行迴顧性統計分析，根據該法測定患者入院時血清PQ質量濃度是否大于1.8 μ.g/mL分為兩組，採用成組t檢驗和Fisher精確概率法對兩組患者的臨床特徵進行統計分析。結果 (1)普通分光光度法檢測含PQ血清樣本時在257 nm波長處未見明顯吸收峰；(2)二階導數分光光度法測定血清PQ質量濃度在0.4～8.0 μg/mL範圍內呈現良好的線性關繫，相關繫數為0.996；迴收率為95.0％～99.5％，相對標準差(RSD)為1.35％～5.41％ (n=6)，檢齣下限為0.05 μg/mL;(3)8例PQ中毒患者血清PQ質量濃度二階導數分光光度法測定值與HPLC法檢測值相吻閤，r=0.995，P＜0.01；(4)血清PQ質量濃度＞1.8 μg/mL組患者存活率為22.2％，痠中毒和少尿髮生率55.6％，縱膈氣腫髮生率77.8％，與血清PQ質量濃度＜1.8 μg/mL組比較差異均有統計學意義(P＜0.05)。結論 (1)普通分光光度法用于測定血清PQ質量濃度不能採用257 rn為檢測波長；(2)二階導數分光光度法用于檢測血清百草枯質量濃度可靠性高；(3)二階導數分光光度法測定值可用于中毒患者的臨床嚴重程度判斷，口服PQ中毒4h後血清質量濃度＞1.8 μg/mL是患者預後不良的重要指標。
목적 평개분광광도법측정혈청백초고(paraquat，PQ)질량농도적가고성급기림상의의。방법 험증보통분광광도법화이계도수분광광도법측정혈청PQ질량농도적검측파장후，채용이계도수분광광도법측정혈청PQ질량농도，학정기선성범위병평개기준학성；채용해법측정8례PQ중독환자혈청PQ질량농도병여고효액상색보법측정치비교분석기가고성；대상해시제십인민의원신병면역과2008년10월지2010년9월수치적구복PQ4h이상인원적21례급성PQ중독환자적자료행회고성통계분석，근거해법측정환자입원시혈청PQ질량농도시부대우1.8 μ.g/mL분위량조，채용성조t검험화Fisher정학개솔법대량조환자적림상특정진행통계분석。결과 (1)보통분광광도법검측함PQ혈청양본시재257 nm파장처미견명현흡수봉；(2)이계도수분광광도법측정혈청PQ질량농도재0.4～8.0 μg/mL범위내정현량호적선성관계，상관계수위0.996；회수솔위95.0％～99.5％，상대표준차(RSD)위1.35％～5.41％ (n=6)，검출하한위0.05 μg/mL;(3)8례PQ중독환자혈청PQ질량농도이계도수분광광도법측정치여HPLC법검측치상문합，r=0.995，P＜0.01；(4)혈청PQ질량농도＞1.8 μg/mL조환자존활솔위22.2％，산중독화소뇨발생솔55.6％，종격기종발생솔77.8％，여혈청PQ질량농도＜1.8 μg/mL조비교차이균유통계학의의(P＜0.05)。결론 (1)보통분광광도법용우측정혈청PQ질량농도불능채용257 rn위검측파장；(2)이계도수분광광도법용우검측혈청백초고질량농도가고성고；(3)이계도수분광광도법측정치가용우중독환자적림상엄중정도판단，구복PQ중독4h후혈청질량농도＞1.8 μg/mL시환자예후불량적중요지표。
Objective To evaluate the reliability and clinical value for detecting paraquat (PQ)concentration in serum by spectrometry. Methods The determinations of wave length for detecting serum PQ concentration by ordinary spectrometry and second-derivative spectrometry were carried out. When the second-derivative spectrometry was used for detecting PQ in serum, the linear range and precision for PQ concentration were well defined. The results of serum PQ concentration determined by second-derivative spectrometry and by HPLC (high performance liquid chromatography) were compared in 8 patient with PQ poisoning. A total of 21 patients with acute poisoning after PQ ingestion over 4 hours admitted from October 2008 through September 2010 were retrospectively studied. Patients were divided into two groups as per the serum concentrations more than 1.8 μg/mL or less than that by second-derivative spectrometry on the day of admission. The severity of clinical manifestations between two groups was analyzed with t-test or Fisher's exact probabilities analysis. Results ( 1 ) The absorption peak of 257 nm could not be found by using ordinary spectrometry to detect the PQ concentration in serum. (2) The calibration curve in the 0. 4 ～ 8.0μg/mL range for detecting PQ concentration by second-derivative spectrometry observed the Beer's law (r =0. 996) . The average retrieval rate of PQ was within the range of 95.0％ ～ 99. 5％ with relative standard deviation (RSD) within 1.35％ ～ 5.41％ ( n = 6), and the lowest detection limit was 0. 05μg/mL. (3) The results of PQ concentrations from 8 patients with PQ poisoning detected by second-derivative spectrometry were consistent with those of the quantitative determinations by HPLC ( r = 0. 995,P＜0. 01 ) . (4) The survival rate of patients with serum PQ concentration more than 1.8 μg/mL was 22. 2％ ,and the incidences of acidosis, oligouria and pneumomediastium in these patients were 55.6％,55. 6％ and 77.8％, respectively. These clinical manifestations were significantly different from those in patients with serum PQ concentration less than 1.8 μg/mL ( P ＜ 0. 05 ) . Conclusions ( 1 ) It was inappropriate to take 257 nm as the determination wave length for detecting serum PQ concentration by ordinary spectrometry. (2) The method of second-derivative spectrometry was reliable for detecting serum PQ concentration. (3) Serum PQ concentration detected by second derivative spectrometry could be used to predict the severity of clinical manifestations of patients with PQ poisoning and was an important predictive factor for poor prognosis if the serum PQ concentration more than 1.8 μg/mL after PQ ingestion over 4 hours.
