丁酰胆碱酯酶活性评估院前急性有机磷农药中毒患者病情及预后的应用研究  

Research on application of BuChE assess prehospital acute organophosphorus pesticide poisoning and the prognosis of patients with the disease

作　　者：范小勇[1] 

机构地区：[1]河南省新乡市中心医院急症科,453000

出　　处：《重庆医学》2014年第30期4028-4029,4033,共3页Chongqing medicine

摘　　要：目的探讨丁酰胆碱酯酶(BuChE)活性评估院前急性有机磷农药中毒(AOPP)患者病情及预后的应用效果。方法选择院前急救AOPP患者110例,所有患者在院前采集静脉血测定BuChE活性,并以入院治疗60d为观察界限,分析BuChE特征曲线及预测指标。结果 110例患者中死亡24例,存活96例,其中死亡组院前BuChE活性为(36.7±34.2)%,存活组院前BuChE活性(67.2±15.4)%,两组差异有统计学意义(P<0.05)。ROC曲线判断AOPP最佳截断点为BuChE活性小于或等于30%正常值。27例BuChE活性小于或等于30%正常值者病死率为74.07%(20/27),93例大于30%正常值者病死率为4.30%(8/93)。两者病死率比较有差异有统计学意义(P<0.01)。当院前AOPP患者危重度的最佳截断点为BuChE活性小于或等于30%正常值,对其死亡预测的特异度为0.954,敏感度0.761,阳性预测值0.825,准确度0.912,约登指数0.716。结论 BuChE活性对AOPP病情具有快速、有效的预测价值,值得临床推广应用。Objective To investigate the evaluation for condition and prognosis of butyrylcholinesterase（BuChE）evaluation for acute organophosphorus pesticide poisoning （AOPP） .Methods 110 cases of AOPP patients were collected ,venous blood of all the patients in pre-hospital was sampled for determination of BuChE activity ,and treatment lasted for 60 d ,then BuChE characteristic curves and forecast indexs were analyzed .Results 24 cases died and 96 cases survived ,pre-hospital BuChE activity of the death group was （36 .7 ± 34 .2）% ,and the survival group was （67 .2 ± 15 .4）% ,there was significant difference between the two groups （P〈0.05） .That BuChE activity≤30% of normal value in ROC curve was the optimal cut-off point to determine the AOPP poi-soning .Among 27 cases of patients ,who BuChE activity ≤30% of normal value ,the death rate was 74 .07% （20/27） ,among 93 cases of patients ,who BuChE activity〉30% of normal value ,the death rate was 4 .30% （8/93） ,there was significant difference between the two groups（P〈0.01） .When the optimal cut-off point of BuChE activity was≤30% of normal value in pre-hospital patients with critical AOPP ,the specific degree of its death prediction was 0.954 ,sensitivity was 0.761 ,positive predictive value was 0.825 ,accuracy was 0.912 ,Youden index was 0.716 .Conclusion BuChE activity is a rapid and effective predicted value for the AOPP ,it is worthy of clinical application .

关 键 词：丁酰胆碱酯酶 急救 中毒 危险性评估 预后 

分 类 号：R595.4[医药卫生—内科学]