CAJ | 학술논문

目的：探讨重度急性有机氟吸入性中毒的早期临床危险因素。方法回顾性分析2004年以来江苏省苏北人民医院收治的急性有机氟吸入性中毒患者的临床资料。依据GBZ66-2002《职业性急性有机氟中毒诊断标准》分为轻、中、重度中毒，重度病例纳入重症组，轻度病例和中度病例均纳入非重症组。调查患者性别、年龄、入院时生命体征（体温、脉搏、呼吸频率、收缩压）、动脉血气分析〔血氧饱和度（SaO2）、氧合指数（PaO2/FiO2）、乳酸（Lac）、二氧化碳分压（PaCO2）、酸碱度（pH值）〕，记录未接受药物治疗前的白细胞计数（WBC）、血小板计数（PLT）、丙氨酸转氨酶（ALT）、肌酐（Cr）、血糖、电解质（钾、钠、氯、钙）、肌酸激酶同工酶（CK-MB）等，所有患者均立即行床边胸部X线片检查，记录胸部X线片肺损伤评分。采用单因素和多因素logistic逐步回归分析，并绘制受试者工作特征曲线（ROC曲线）评价各临床危险因素的诊断价值。结果62例符合入选标准，重症组36例，非重症组16例。单因素分析显示，脉搏、呼吸频率、SaO2、PaO2/FiO2、Lac、WBC、pH值、肺损伤评分7项指标差异均有统计学意义（P＜0.05或P＜0.01）；logistic多元回归分析显示，PaO2/FiO2、血WBC、Lac、胸部X线片肺损伤评分是预测重度有机氟吸入中毒的独立危险因素，PaO2/FiO2的ROC曲线下面积（AUC）最高（为0.884），95%可信区间（95%CI）为0.784～0.984，临界值为96.50 mmHg（1 mmHg＝0.133 kPa），敏感度为75.6%，特异度为95.2%，阳性预测值（PPV）为92.3%，阴性预测值（NPV）为71.4%，其余依次为WBC（AUC 0.846，95%CI0.728～0.965，临界值12.15×109/L）、Lac（AUC 0.800，95%CI 0.662～0.938，临界值4.2 mmol/L）、胸部X线片肺损伤评分（AUC 0.795，95%CI 0.652～0.938，临界值2.50分），敏感度分别为90.2%、83.6%、88.5%，特异度分别为90.2%、83.6%、88.5%，PPV分别为86.7%、82.4%、85.8%，NPV分别为72.0%、73.9%、69.2%。结论 PaO2/FiO2、血WBC、Lac，胸部X线片肺损伤评分可作为判断重度急性有机氟吸入性中毒早期的临床危险因素。目的：探討重度急性有機氟吸入性中毒的早期臨床危險因素。方法迴顧性分析2004年以來江囌省囌北人民醫院收治的急性有機氟吸入性中毒患者的臨床資料。依據GBZ66-2002《職業性急性有機氟中毒診斷標準》分為輕、中、重度中毒，重度病例納入重癥組，輕度病例和中度病例均納入非重癥組。調查患者性彆、年齡、入院時生命體徵（體溫、脈搏、呼吸頻率、收縮壓）、動脈血氣分析〔血氧飽和度（SaO2）、氧閤指數（PaO2/FiO2）、乳痠（Lac）、二氧化碳分壓（PaCO2）、痠堿度（pH值）〕，記錄未接受藥物治療前的白細胞計數（WBC）、血小闆計數（PLT）、丙氨痠轉氨酶（ALT）、肌酐（Cr）、血糖、電解質（鉀、鈉、氯、鈣）、肌痠激酶同工酶（CK-MB）等，所有患者均立即行床邊胸部X線片檢查，記錄胸部X線片肺損傷評分。採用單因素和多因素logistic逐步迴歸分析，併繪製受試者工作特徵麯線（ROC麯線）評價各臨床危險因素的診斷價值。結果62例符閤入選標準，重癥組36例，非重癥組16例。單因素分析顯示，脈搏、呼吸頻率、SaO2、PaO2/FiO2、Lac、WBC、pH值、肺損傷評分7項指標差異均有統計學意義（P＜0.05或P＜0.01）；logistic多元迴歸分析顯示，PaO2/FiO2、血WBC、Lac、胸部X線片肺損傷評分是預測重度有機氟吸入中毒的獨立危險因素，PaO2/FiO2的ROC麯線下麵積（AUC）最高（為0.884），95%可信區間（95%CI）為0.784～0.984，臨界值為96.50 mmHg（1 mmHg＝0.133 kPa），敏感度為75.6%，特異度為95.2%，暘性預測值（PPV）為92.3%，陰性預測值（NPV）為71.4%，其餘依次為WBC（AUC 0.846，95%CI0.728～0.965，臨界值12.15×109/L）、Lac（AUC 0.800，95%CI 0.662～0.938，臨界值4.2 mmol/L）、胸部X線片肺損傷評分（AUC 0.795，95%CI 0.652～0.938，臨界值2.50分），敏感度分彆為90.2%、83.6%、88.5%，特異度分彆為90.2%、83.6%、88.5%，PPV分彆為86.7%、82.4%、85.8%，NPV分彆為72.0%、73.9%、69.2%。結論 PaO2/FiO2、血WBC、Lac，胸部X線片肺損傷評分可作為判斷重度急性有機氟吸入性中毒早期的臨床危險因素。
목적：탐토중도급성유궤불흡입성중독적조기림상위험인소。방법회고성분석2004년이래강소성소북인민의원수치적급성유궤불흡입성중독환자적림상자료。의거GBZ66-2002《직업성급성유궤불중독진단표준》분위경、중、중도중독，중도병례납입중증조，경도병례화중도병례균납입비중증조。조사환자성별、년령、입원시생명체정（체온、맥박、호흡빈솔、수축압）、동맥혈기분석〔혈양포화도（SaO2）、양합지수（PaO2/FiO2）、유산（Lac）、이양화탄분압（PaCO2）、산감도（pH치）〕，기록미접수약물치료전적백세포계수（WBC）、혈소판계수（PLT）、병안산전안매（ALT）、기항（Cr）、혈당、전해질（갑、납、록、개）、기산격매동공매（CK-MB）등，소유환자균립즉행상변흉부X선편검사，기록흉부X선편폐손상평분。채용단인소화다인소logistic축보회귀분석，병회제수시자공작특정곡선（ROC곡선）평개각림상위험인소적진단개치。결과62례부합입선표준，중증조36례，비중증조16례。단인소분석현시，맥박、호흡빈솔、SaO2、PaO2/FiO2、Lac、WBC、pH치、폐손상평분7항지표차이균유통계학의의（P＜0.05혹P＜0.01）；logistic다원회귀분석현시，PaO2/FiO2、혈WBC、Lac、흉부X선편폐손상평분시예측중도유궤불흡입중독적독립위험인소，PaO2/FiO2적ROC곡선하면적（AUC）최고（위0.884），95%가신구간（95%CI）위0.784～0.984，림계치위96.50 mmHg（1 mmHg＝0.133 kPa），민감도위75.6%，특이도위95.2%，양성예측치（PPV）위92.3%，음성예측치（NPV）위71.4%，기여의차위WBC（AUC 0.846，95%CI0.728～0.965，림계치12.15×109/L）、Lac（AUC 0.800，95%CI 0.662～0.938，림계치4.2 mmol/L）、흉부X선편폐손상평분（AUC 0.795，95%CI 0.652～0.938，림계치2.50분），민감도분별위90.2%、83.6%、88.5%，특이도분별위90.2%、83.6%、88.5%，PPV분별위86.7%、82.4%、85.8%，NPV분별위72.0%、73.9%、69.2%。결론 PaO2/FiO2、혈WBC、Lac，흉부X선편폐손상평분가작위판단중도급성유궤불흡입성중독조기적림상위험인소。
ObjectiveTo investigate the early clinical risk factors of severe acute inhaled organic fluorine poisoning.Methods The clinical data of patients with acute poisoning of organic fluorine inhalation admitted since 2004 in Northern Jiangsu People's Hospital were retrospectively analyzed. According toDiagnostic Criteria of Occupational Acute Fluorohydrocarbon Poisoning(GBZ66-2002), all the patients were divided into three groups: mild, moderate and severe poisoning groups, the severe cases were included in the intensive group, and the others were grouped in the non-intensive group. The contents in the survey were as follows: gender, age, vital signs on admission (body temperature, pulse rate, respiratory rate, systolic blood pressure), arterial blood gas analysis record〔arterial oxygen saturation(SaO2), oxygenation index(PaO2/FiO2), lactic acid(Lac) and arterial partial pressure of carbon dioxide(PaCO2), pH value(pH)〕. Before treatment, the white blood cell(WBC) count, platelet(PLT) count, levels of alanine transaminase(ALT), creatinine(Cr), blood glucose, electrolytes(potassium, sodium, chloride, calcium), creatine kinase isoenzyme(CK-MB), etc. were examined and recorded. All the patients were immediately arranged for bedside chest X-ray examination, and the chest X-ray lung injury scores were recorded. By univariate and multivariate logistic regression analyses, the receiver operating characteristic curve(ROC curve) was drawn to evaluate the diagnostic value of the clinical risk factors.Results Sixty-two cases consisting with the standard criteria of enrollment were collected in the study, 36 cases being in intensive group and 26 cases in non-intensive group. The univariate analysis showed that the differences in pulse rate, respiratory rate, PaO2/FiO2, WBC, SaO2, Lac, pH, and lung injury score were statistically significant(P<0.05 orP<0.01). Logistic multiple regression analysis showed that PaO2/FiO2, WBC, Lac and chest X-ray lung injury score were the four indexes for predicting the independent risk factors of severe acute inhaled organic fluorine poisoning. The area under ROC curve(AUC) of PaO2/FiO2 was the highest(0.884), 95% confidence interval(95%CI) was 0.784 - 0.984, the critical value was 96.5 mmHg(1 mmHg=0.133 kPa), with the sensitivity of 75.6%, specificity of 95.2%, positive predictive value(PPV) of 92.3% and the negative predictive value(NPV) of 71.4%, in sequence, the rest were WBC(AUC 0.846, 95%CI 0.728 - 0.965, the criticalvalue 12.15×109/L), Lac(AUC 0.800, 95%CI 0.662 - 0.938, the critical value 4.2 mmol/L), chest X-ray lung injury score(AUC 0.795, 95%CI 0.652 - 0.938, the critical value 2.50), the sensitivity of the above three items was 90.2%, 83.6%, 88.5%, specificity was 90.2%, 83.6%, 88.5%, the PPV was 86.7%, 82.4%, 85.8% and NPV was 72.0%, 73.9%, 69.2% respectively.ConclusionThe blood WBC count, Lac, PaO2/FiO2 and chest X-ray lung injury score can be used as the early clinical risk factors of severe acute inhaled organic fluorine poisoning.