三种方法对急性百草枯中毒严重程度和预后评估价值的比较  

Predictive value of 3 methods in severity evaluation and prognosis of acute paraquat poisoning

作　　者：杜宇[1] 牟奕[2] 

机构地区：[1]四川大学华西第四医院急诊科,成都610041 [2]四川大学华西医院麻醉研究室,成都610041

出　　处：《中南大学学报（医学版）》2013年第7期737-742,共6页Journal of Central South University ：Medical Science

摘　　要：目的:比较入院时血浆百草枯浓度、百草枯中毒严重指数(SIPP)及急性生理学及慢性健康状况评分Ⅱ(APACHE Ⅱ)3种评估方法在急性百草枯中毒严重度和预后评估中的价值。方法:采集73例口服急性百草枯中毒患者入院时血浆百草枯浓度及各项临床资料计算SIPP和APACHE Ⅱ,根据患者医院内及出院7 d内的预后结果对3种评估方法进行分辨度和校准度检验,以此评估预测价值。结果:3种评估方法均有较好的分辨度(>0.8),其中SIPP的ROC曲线下面积(0.938)均大于血浆百草枯浓度(0.857)和APACHE Ⅱ(0.801),且差异有统计学意义(z=2.429,2.021;P=0.015,0.043),而后两者差异无统计学意义(z=0.755,P=0.450)。Hosmer-Lemeshow拟合优度检验显示三者均有较好的校准度(P>0.05)。结论:3种评估方法均可用于急性百草枯中毒严重度和预后评估,但SIPP比其他两个评估方法更具优势,入院时血浆百草枯浓度相对次之,但在没有条件实施血浆百草枯浓度测定的医疗机构也可采用APACHE Ⅱ为急性百草枯中毒预后评估提供参考。Objective： To evaluate the predictive value of 3 methods, namely plasma paraquat concentration, severity index of paraquat poisoning （SIPP）, and acute physiology and chronic health evaluation （APACHE Ⅱ） in severity evaluation and prognosis of acute paraquat poisoning. Methods： A total of 73 acute paraquat poisoning patients with oral administration were collected. Paraquat concentration in the plasma and other parameters on admission for SIPP and APACHE Ⅱ were taken from medical records. According to the clinical outcome in the hospital or 7 days after the discharge, discrimination and calibration test were performed to evaluate the prognosis of the 3 methods. Results： Discrimination of the 3 methods was greater than 0.8, and the area under the receiveroperator curve for SIPP （0.938） was greater than paraquat concentration in the plasma （0.857） and APACHE Ⅱ （0.801） with statistical significance （z=2.429, 2.021; P=0.015, 0.043）. Difference in plasma paraquat concentration （0.857） and APACHEⅡ （0.801） had no statistical significance （z=0.755, P=0.450）. Hosmer-Lemeshow good fit test suggested better calibration value with statistical significance for the 3 methods （P〉0.05）. Conclusion： The 3 methods are valid in the severity evaluation and prognosis of acute paraquat poisoning. SIPP is the most preferred method, followed by paraquat concentration on admission. When there is no facility to measure paraqut concentration, APACHE Ⅱcan be used as a reference for the death risk in acute paraquat poisoning.

关 键 词：急性百草枯中毒 血浆百草枯浓度 百草枯中毒严重指数 APACHEⅡ 

分 类 号：R595.4[医药卫生—内科学]