中华危重病急救医学
中華危重病急救醫學
중화위중병급구의학
Chinese Critical Care Medicine
2013年
9期
519-522
,共4页
百草枯%中毒%乳酸%百草枯中毒严重指数%预后
百草枯%中毒%乳痠%百草枯中毒嚴重指數%預後
백초고%중독%유산%백초고중독엄중지수%예후
Paraquat%Poisoning%Lactic acid%Severity index of paraqaut poisoning%Prognosis
目的 探讨血清乳酸水平对急性百草枯中毒(APP)患者预后的预测价值.方法 回顾性分析168例APP患者的临床资料,收集患者入院时的血清乳酸水平和血浆百草枯浓度,计算百草枯中毒严重指数(SIPP),并根据SIPP将患者分为＜10、10 ～ 50、≥50 h·mg·L-1 3组,分析血清乳酸水平与SIPP的相关性及对预后的预测价值.结果 SIPP水平越高,患者乳酸水平(mmol/L)越高[200(1.50,2.83)、3.10(1.73,5.15)、8.95(5.90,13.10),均P＜ 0.05]；SIPP与血清乳酸水平呈正相关(r=0.569,P＜0.05).SIPP水平越高,患者病死率越高 [17.4％(15/86)、61.5％(24/39)、97.7％(42/43),均P＜0.05]；SIPP≥50 h·mg· L-1组死亡患者的生存时间(d)明显短于SIPP＜ 10 h·mg· L-1组和10～ 50 h·mg· L-1组[2.0(1.0,3.0)比9.0(4.0,11.0)、5.0(3.0,10.0),均P＜0.05]；乳酸水平及SIPP与死亡患者生存时间均呈显著负相关(r1=-0.778,r2=-0.621,均P＜0.05)；logistic回归分析显示,乳酸、SIPP与预后有关[乳酸:优势比(OR)=1.758,95％可信区间(95％CI)为1.278 ～ 2.417；SIPP:OR=1.063,95％CI为1.025 ～ 1.103,均P=0.001]；乳酸及SIPP与预后的受试者工作特征曲线(ROC曲线)下面积分别为0.885和0.897(均P＜ 0.05),乳酸≥3.35 mmol/L为最佳界值,其对预测患者死亡的敏感度、特异度、阳性预测值、阴性预测值、阳性似然比、阴性似然比和准确度分别为74.07％、90.80％、88.24％、79.00％、8.056、0.286和82.74％,预测价值接近于SIPP≥13.83 h·mg·L-1的界值(77.78％、91.95％、90.00％、81.63％、9.677、0.242和85.12％).结论 血清乳酸水平的变化对于APP患者的严重程度及预后具有评估价值,以乳酸≥3.35 mmol/L为界值可作为一种简便易行的指标推断APP患者的预后.
目的 探討血清乳痠水平對急性百草枯中毒(APP)患者預後的預測價值.方法 迴顧性分析168例APP患者的臨床資料,收集患者入院時的血清乳痠水平和血漿百草枯濃度,計算百草枯中毒嚴重指數(SIPP),併根據SIPP將患者分為＜10、10 ～ 50、≥50 h·mg·L-1 3組,分析血清乳痠水平與SIPP的相關性及對預後的預測價值.結果 SIPP水平越高,患者乳痠水平(mmol/L)越高[200(1.50,2.83)、3.10(1.73,5.15)、8.95(5.90,13.10),均P＜ 0.05]；SIPP與血清乳痠水平呈正相關(r=0.569,P＜0.05).SIPP水平越高,患者病死率越高 [17.4％(15/86)、61.5％(24/39)、97.7％(42/43),均P＜0.05]；SIPP≥50 h·mg· L-1組死亡患者的生存時間(d)明顯短于SIPP＜ 10 h·mg· L-1組和10～ 50 h·mg· L-1組[2.0(1.0,3.0)比9.0(4.0,11.0)、5.0(3.0,10.0),均P＜0.05]；乳痠水平及SIPP與死亡患者生存時間均呈顯著負相關(r1=-0.778,r2=-0.621,均P＜0.05)；logistic迴歸分析顯示,乳痠、SIPP與預後有關[乳痠:優勢比(OR)=1.758,95％可信區間(95％CI)為1.278 ～ 2.417；SIPP:OR=1.063,95％CI為1.025 ～ 1.103,均P=0.001]；乳痠及SIPP與預後的受試者工作特徵麯線(ROC麯線)下麵積分彆為0.885和0.897(均P＜ 0.05),乳痠≥3.35 mmol/L為最佳界值,其對預測患者死亡的敏感度、特異度、暘性預測值、陰性預測值、暘性似然比、陰性似然比和準確度分彆為74.07％、90.80％、88.24％、79.00％、8.056、0.286和82.74％,預測價值接近于SIPP≥13.83 h·mg·L-1的界值(77.78％、91.95％、90.00％、81.63％、9.677、0.242和85.12％).結論 血清乳痠水平的變化對于APP患者的嚴重程度及預後具有評估價值,以乳痠≥3.35 mmol/L為界值可作為一種簡便易行的指標推斷APP患者的預後.
목적 탐토혈청유산수평대급성백초고중독(APP)환자예후적예측개치.방법 회고성분석168례APP환자적림상자료,수집환자입원시적혈청유산수평화혈장백초고농도,계산백초고중독엄중지수(SIPP),병근거SIPP장환자분위＜10、10 ～ 50、≥50 h·mg·L-1 3조,분석혈청유산수평여SIPP적상관성급대예후적예측개치.결과 SIPP수평월고,환자유산수평(mmol/L)월고[200(1.50,2.83)、3.10(1.73,5.15)、8.95(5.90,13.10),균P＜ 0.05]；SIPP여혈청유산수평정정상관(r=0.569,P＜0.05).SIPP수평월고,환자병사솔월고 [17.4％(15/86)、61.5％(24/39)、97.7％(42/43),균P＜0.05]；SIPP≥50 h·mg· L-1조사망환자적생존시간(d)명현단우SIPP＜ 10 h·mg· L-1조화10～ 50 h·mg· L-1조[2.0(1.0,3.0)비9.0(4.0,11.0)、5.0(3.0,10.0),균P＜0.05]；유산수평급SIPP여사망환자생존시간균정현저부상관(r1=-0.778,r2=-0.621,균P＜0.05)；logistic회귀분석현시,유산、SIPP여예후유관[유산:우세비(OR)=1.758,95％가신구간(95％CI)위1.278 ～ 2.417；SIPP:OR=1.063,95％CI위1.025 ～ 1.103,균P=0.001]；유산급SIPP여예후적수시자공작특정곡선(ROC곡선)하면적분별위0.885화0.897(균P＜ 0.05),유산≥3.35 mmol/L위최가계치,기대예측환자사망적민감도、특이도、양성예측치、음성예측치、양성사연비、음성사연비화준학도분별위74.07％、90.80％、88.24％、79.00％、8.056、0.286화82.74％,예측개치접근우SIPP≥13.83 h·mg·L-1적계치(77.78％、91.95％、90.00％、81.63％、9.677、0.242화85.12％).결론 혈청유산수평적변화대우APP환자적엄중정도급예후구유평고개치,이유산≥3.35 mmol/L위계치가작위일충간편역행적지표추단APP환자적예후.
Objective To discuss the role of serum lactic acid (Lac) level in evaluation of prognosis of acute paraquat poisoning (APP) patients.Methods Clinical data from 168 APP patients were retrospectively analyzed.The serum Lac level and the plasma paraquat concentrations at admission were collected,and the severity index of paraqaut poisoning (SIPP) were calculated.The patients were divided into ＜ 10,10-50,≥ 50 h·mg· L-1 groups on the basis of SIPP.The correlation between Lac and SIPP was analyzed,as well as the role in evaluating prognosis.Results The higher the SIPP level,the higher the Lac level [mmol/L:2.00 (1.50,2.83),3.10 (1.73,5.15),8.95 (5.90,13.10),all P＜0.05] ; Lac was correlated positively with SIPP (r=0.569,P＜0.05).The higher the SIPP,the higher the mortality of patients [17.4％ (15/86),61.5％ (24/39),97.7％ (42/43),all P＜0.05].The survival days of SIPP≥50 h ·mg·L-1 group was shorter than that in SIPP＜ 10 h·mg·L-1 group and 10-50 h·mg·L-1 group [2.0 (1.0,3.0) vs.9.0 (4.0,11.0)and 5.0 (3.0,10.0),both P＜0.05].A negative correlation was found between Lac,SIPP and survival days in non-survivors (r1 =-0.778,r2=-0.621,both P＜0.05).Logistic regression analyses showed either Lac or SIPP was of prognostic significance [odds ratio (OR) of Lac:1.758,95％ confidence interval (95％ CI) 1.278-2.417; OR of SIPP:1.063,95％CI 1.025-1.103,both P=0.001].The area under the receiver operating characteristic curve (ROC curve) of Lac,SIPP and prognosis were 0.885 and 0.897 respectively (both P＜0.05),Lac ≥ 3.35 mmol/L was the best cut-off value,the sensitivity,specificity,positive predictive value,negative predictive value,positive likelihood ratio,negative likelihood ratio and accuracy for predicting the death were 74.07％,90.80％,88.24％,79.00％,8.056,0.286 and 82.74％ respectively; the evaluation value was closed to SIPP≥ 13.83 h·mg·L-1 (77.78％,91.95％,90.00％,81.63％,9.677,0.242 and 85.12％,respectively).Conclusion The change in serum Lac level has evaluation value of the severity and prognosis for APP patients,and Lac ≥ 3.35 mmol/L can be made as a simple and easy indicator for prognosis of APP patients.
