CAJ | 학술논문

目的：通过回顾性地总结临床病例资料，探讨急性口服百草枯（paraquat，PQ）中毒患者早期血清肌酐值变化与出现呼吸衰竭的关系，以期在中毒早期通过血清肌酐水平的变化预测患者病程中出现呼吸衰竭的可能性，指导临床诊断及治疗。方法选取军事医学科学院附属医院中毒救治科2008～2012年 PQ中毒患者72例，按照病程中是否发生呼吸衰竭将其分为两组， A组为出现呼吸衰竭的患者，共28例；B组为未出现呼吸衰竭的患者，共44例。取中毒后来院就诊首次测得血清肌酐基值及中毒48 h内血清肌酐最高值，计算二者差值及比率进行比较。在此基础上，分别计算灵敏度、特异度、准确度、Youden指数、ROC曲线下面积，绘制ROC曲线。根据准确度和Youden指数确定各指标的最佳预测界值及预测效果。结果两组患者在肌酐基值、高值、比率、差值的差异存在统计学意义。肌酐基值的最佳预测界值为53μmol/L，预测效果中等。其余3项预测效果均较佳，其中肌酐高值的最佳预测界值为183μmol/L，肌酐比率的最佳预测界值为3．39，肌酐差值的最佳预测界值为113μmol/L。结论在PQ中毒早期48 h内，血清肌酐水平上升速率越快，出现呼吸衰竭的可能性越大。通过计算中毒后血清肌酐基值、48 h内高值、差值及比率，与研究得出的各个预测界值进行比较，如达到预测界值，则说明发生呼吸衰竭的可能性极大。
목적：통과회고성지총결림상병례자료，탐토급성구복백초고（paraquat，PQ）중독환자조기혈청기항치변화여출현호흡쇠갈적관계，이기재중독조기통과혈청기항수평적변화예측환자병정중출현호흡쇠갈적가능성，지도림상진단급치료。방법선취군사의학과학원부속의원중독구치과2008～2012년 PQ중독환자72례，안조병정중시부발생호흡쇠갈장기분위량조， A조위출현호흡쇠갈적환자，공28례；B조위미출현호흡쇠갈적환자，공44례。취중독후래원취진수차측득혈청기항기치급중독48 h내혈청기항최고치，계산이자차치급비솔진행비교。재차기출상，분별계산령민도、특이도、준학도、Youden지수、ROC곡선하면적，회제ROC곡선。근거준학도화Youden지수학정각지표적최가예측계치급예측효과。결과량조환자재기항기치、고치、비솔、차치적차이존재통계학의의。기항기치적최가예측계치위53μmol/L，예측효과중등。기여3항예측효과균교가，기중기항고치적최가예측계치위183μmol/L，기항비솔적최가예측계치위3．39，기항차치적최가예측계치위113μmol/L。결론재PQ중독조기48 h내，혈청기항수평상승속솔월쾌，출현호흡쇠갈적가능성월대。통과계산중독후혈청기항기치、48 h내고치、차치급비솔，여연구득출적각개예측계치진행비교，여체도예측계치，칙설명발생호흡쇠갈적가능성겁대。
Objective To retrospectively review the clinical data of acute oral paraquat (PQ) poisoning patients and the relationship of early serum creatinine leveles with respiratory failure , to predict and guide the clinical diagnosis and treatment .Methods Seventy-two PQ poisoning patients from the 2008 to 2012 , according to the occurrence of respiratory failure were divided into two groups , group A:patients with respiratory failure (28 cases);and group B:patients without respiratory failure(44 cases).The first serum creatinine detection early after poisoning as the basic value and the highest value within 48 hours, and the difference between the two ratios was compared .Then the sensitivity, specificity, accuracy, Youden index, receiver operating characteristic(ROC) area under the curve(AUC) were also calculated, and the ROC AUC was drawn.Results The creatinine basic value ,the highest valve and their ratio were obtained , and the difference was statistically significant .The best predictor boarder of creatinine basic value was 53 μmol/L, with forecasting moderate effect,and that of the highest value ,their ratio and the creatinine difference value was 183μmol/L, 3.39 and 113μmol/L, respectively.Conclusion The higher the early serum creatinine level rises , the higher the risk of respiratory failure increa-ses after PQ poisoning .The basic value , the highest value within 48 hours and their difference and ratio could predict the possibility of respiratory failure after PQ intoxication .