剩余碱水平对百草枯中毒患者预后的预测价值  

Value of base excess in predicting the prognosis of patients with paraquat poisoning

作　　者：康晓文[1] 仝欢[1] 曹凯强 莫清飞[1] 李玲文[1] 洪广亮[1] 毛璐[1] 李东[1] 赵光举[1] 卢中秋[1] 

机构地区：[1]温州医科大学附属第一医院急诊医学中心,325000

出　　处：《中华劳动卫生职业病杂志》2017年第1期25-29,共5页Chinese Journal of Industrial Hygiene and Occupational Diseases

基　　金：浙江省中医药重点学科计划（2012-XK-A28）;浙江省“十二五”重点学科建设项目（2012-207）;浙江省医学创新学科建设项目（11-CX26）

摘　　要：目的探讨急性百草枯中毒患者的预后影响因素，分析剩余碱（BE）水平与血浆百草枯浓度的相关性以及对急性百草枯中毒患者预后的预测价值。方法回顾性分析2009年1月至2015年8月间我院急诊重症监护室（EICU）收治的84例急性百草枯中毒患者的临床资料，收集患者入院后24h内的BE值和血浆百草枯浓度、中毒至洗胃时间、中毒至血液灌流（He）时间、百草枯中毒严重指数（SIPP）以及白细胞（WBC）、中性粒细胞比（N％）、血红蛋白（Hb）、血肌酐（Cr）、尿素氮（BUN）、丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、血糖、血清钾、剩余碱（BE）、氧分压（PaO2）、二氧化碳分压（PaCO2）、pH值等指标。按随访30d后的转归情况分为死亡组（41例），存活组（43例），研究急性百草枯中毒患者预后的影响因素并分析BE水平与血浆百草枯浓度的相关性及对预后的预测价值。结果Logistic回归分析显示，与急性百草枯中毒患者预后有关的因素有BE、血浆百草枯浓度、AL．T、AST、Cr[BE：OR=O．511，95％可信区间为0．267～0．978；血浆百草枯浓度：OR=0．999，95％可信区间为0．999～1．000；均P〈0．osl。BE及血浆百草枯浓度与预后的受试者工作特征（ROC）曲线下面积（AUC）分别为0．775和0．927，BE≤-1．7mmol／L为最佳界值，其对预测患者死亡的敏感度、特异度分别为82．9％、62．8％，预测价值低于血浆百草枯浓度〉3273．935ng／ml的界值（auc0．927，78．0％、95．3％）。BE水平与血浆百草枯浓度呈负相关（r=-0．4，P〈0．01）。结论BE与血浆百草枯浓度呈负相关且BE水平对急性百草枯中毒患者的死亡具有一定的预测价值。Objective To explore prognostic factors of acute paraquat poisoning （APP）, analyze the correlation between base excess （BE） and plasma concentration of paraquat （C-PQ） and discuss BE level in evaluation of prognosis of acute paraquat poisoning patients. Methods We retrospectively selected 84 APP patients who admitted to Emergency Intensive Care Unit （EICU） of our hospital from 2009.9.1 to 2015.8.31. Clinical data from 84 APP patients were analyzed. BE, C-PQ, time of gastric lavagesinee ingestion,time of hemoperfusion since ingestion ,severity index of paraquat poisoning （SIPP）, white blood cell （WBC）, percentage of neutrophils （N%）, hemoglobin （HB）, creatinine （Cr）, alanine aminotransferase （ALT）, aspartate aminotransferase （AST）, partial pressure of oxygen （PaO2）, partial pressure of carbon dioxide （PaCO2） and other laboratory parameters were measured. A total of 41 patients in non-survivors died during the 30 days after admission and 43 patients in survivors survived during the 30 days. The factors of prognosis in paraquat poisoining and the role of BE in evaluating prognosis was analyzed, as well as the correlation between BE and c- PQ. Results 1.Logistic regression analyses showed BE,C-PQ,ALT,AST,Cr was of prognostic significance [odds ratio （OR） of BE： 0.511, 95%CI0.267, 0.978; C-PQ..-=0.999, 95%CI0.999, 1.000; both P〈0.05]; 2.The area under the receiver operating characteristic curve（ROC curve） of BE, C-PQ and prognosis were 0.775,0.927 respectively, BE ≤-1.7 mmol/L was the best cut-off value, the sensitivity,specificity for predicting were 82.9%, 62.8%, the evaluation value was lower to C-PQ〉3 273.935 ng/ml （AUC 0.927, 78.0%, 95.3%）;3.BE negative correlated with C-PQ[-1.100 （-4.100, -0.200）, -5.900 （-8.650, -2.500）, both P〈O.05]. （r=-O.4,P〈O.O1）.Conclusion These results suggest that BE may be useful for the prediction of prognosis in PQ poisoning and BE negative correlated with C-PQ.

关 键 词：百草枯 中毒 预后 剩余碱 

分 类 号：R595.4[医药卫生—内科学]