CAJ | 학술논문

目的分析急性百草枯中毒(acute paraquat poisoning,APP)患者病程早期动脉血乳酸(lactate,Lac)值及6h乳酸清除率(lactate clearance rate,LCR)的特点,探讨与APP患者预后的关系.方法对2009年1月至2013年12月住于福建省立医院急危重症监护病房(EICU)的APP患者临床资料进行回顾性分析,根据服毒后28 d的转归将患者分为存活组及死亡组进行对照研究,判定入院初始动脉血Lac及6 h LCR对于患者预后的预测价值.结果共纳入符合标准的132例APP患者,年龄15 ～ 71岁,30岁(18岁)[M(IQR)];男性70例,女性62例;服毒剂量5 ～ 200 mL,20mL (37.25 mL) [M (IQR)];服毒至就诊时间4～ 312 h,6h (8.75h) [M(IQR)].经随访服毒后28 d死亡68例,存活64例,病死率51.51％.死亡组的服毒剂量明显高于存活组,服毒剂量预测患者28 d病死率ROC曲线下面积为.86 (95％ CI:0.80 ～ 0.92),截断值为27.5 mL,灵敏度75％,特异度85.9％,Youden指数0.609;死亡组的入院初始动脉Lac值、APACHEⅡ评分值明显高于存活组,入院初始动脉血Lac值预测患者28 d病死率的ROC曲线下面积为0.99 (95％ CI:0.99 ～ 1.00),截断值为5.050,灵敏度98.5％,特异度100％,Youden指数0.985.死亡组的6h乳酸清除率明显低于存活组,6 h LCR预测患者28 d病死率的ROC曲线下面积为0.99(95％ CI:0.97 ～ 1.00),截断值为17.28％,灵敏度100％,特异度97.1％,Youden指数0.971.结论 APP患者病程早期动脉血Lac值及6 h LCR能作为预测患者预后的指标之一,对预后的判断具有较高的临床价值.
목적 분석급성백초고중독(acute paraquat poisoning,APP)환자병정조기동맥혈유산(lactate,Lac)치급6h유산청제솔(lactate clearance rate,LCR)적특점,탐토여APP환자예후적관계.방법 대2009년1월지2013년12월주우복건성립의원급위중증감호병방(EICU)적APP환자림상자료진행회고성분석,근거복독후28 d적전귀장환자분위존활조급사망조진행대조연구,판정입원초시동맥혈Lac급6 h LCR대우환자예후적예측개치.결과 공납입부합표준적132례APP환자,년령15 ～ 71세,30세(18세)[M(IQR)];남성70례,녀성62례;복독제량5 ～ 200 mL,20mL (37.25 mL) [M (IQR)];복독지취진시간4～ 312 h,6h (8.75h) [M(IQR)].경수방복독후28 d사망68례,존활64례,병사솔51.51％.사망조적복독제량명현고우존활조,복독제량예측환자28 d병사솔ROC곡선하면적위.86 (95％ CI:0.80 ～ 0.92),절단치위27.5 mL,령민도75％,특이도85.9％,Youden지수0.609;사망조적입원초시동맥Lac치、APACHEⅡ평분치명현고우존활조,입원초시동맥혈Lac치예측환자28 d병사솔적ROC곡선하면적위0.99 (95％ CI:0.99 ～ 1.00),절단치위5.050,령민도98.5％,특이도100％,Youden지수0.985.사망조적6h유산청제솔명현저우존활조,6 h LCR예측환자28 d병사솔적ROC곡선하면적위0.99(95％ CI:0.97 ～ 1.00),절단치위17.28％,령민도100％,특이도97.1％,Youden지수0.971.결론 APP환자병정조기동맥혈Lac치급6 h LCR능작위예측환자예후적지표지일,대예후적판단구유교고적림상개치.
Objective To investigate the correlation of the initial arterial lactate (Lac) and 6-h lactate clearance rate (LCR) with prognosis in patients with acute paraquat poisoning (APP).Methods The included 132 APP patients (70 males and 62 females,age ranging 15-71,30 (18) [M (IQR)]treated at a single center between January 2009 and December 2013.Patients were divided into two groups:group A,survivors ＞ 28 days after admission (n =64); and group B,those died ≤ 28 days after admission (n =68).The prognostic values of arterial Lac and 6-h LCR during the acute stage of poisoning were evaluated.Results Paraquat dose ranged from 5-200 mL,20 mL (37.25 mL) [M (IQR)].The average time from poisoning to arrival at the emergency department was ranging 4-312 h,6 h (8.75h) [M (IQR)].Total mortality was 51.51％.There were no differences in age,gender,and length of time elapsed from poisoning to diagnosis between two groups.Survivors had a significantly lower dose of paraquat ingested compared with nonsurvivors (P ＜ 0.05).An ROC curve analysis determined that the dose had an area of 0.86 (95％ CI:0.80-0.92) and the volume cut-off point was 27.5 mL to predict the prognosis in patients with acute paraquat poisoning (75％ sensitivity,85.9％ specificity,Youden index 0.609).The initial arterial lactate level was higher in nonsurvivors than that in survivors.The ROC curve analysis indicated that the initial arterial lactate level had an area of 0.99 (95％ CI:0.99-1.00) and the concentration cut-off point was 5.050 mmoL/L to predicti prognosis in patients with acute paraquat poisoning (sensitivity 98.5％,specificity 100％,Youden index 0.985).The 6 h LCR was lower in nonsurvivors than that in survivors.ROC curve analysis showed that the 6-h LCR had an area of 0.99 (95 ％ CI:0.97-1.00) and the concentration cut-off point was 17.28％ to predict prognosis in APP patients (sensitivity 100％,specificity 97.1％,Youden index 0.971).Conclusions In the early stages of APP,initial arterial Lac and 6-h LCR are closely related to prognosis and may serve as prognostic factors.