早期脑氧利用率对一氧化碳中毒迟发性脑病的预测  

Value of early-stage cerebral oxygen utilization coefficient in predicting delayed encephalopathy after acute carbon monoxide poisoning

作　　者：刘倩[1] 李伟[1] 李娜[3] 肖青勉[2] 何佳起 王维展[3] 齐洪娜[3] 王璞[1] Liu Qian Li Wei Li Na Xiao Qingmian He Jiaqi Wang Weizhan Qi Hongna Wang Pu(Department of Emergency, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui 053000, China Department of Emergency, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui 053000, China)

机构地区：[1]河北医科大学哈励逊国际和平医院EICU,衡水053000 [2]河北医科大学哈励逊国际和平医院急诊病房,衡水053000 [3]河北医科大学哈励逊国际和平医院急救医学部,衡水053000

出　　处：《中华劳动卫生职业病杂志》2017年第5期348-350,共3页Chinese Journal of Industrial Hygiene and Occupational Diseases

基　　金：河北省衡水市科学技术研究与发展计划项目（13019A）

摘　　要：目的探讨急性重度一氧化碳中毒早期阶段脑氧利用率（O2UCc）的动态变化对急性一氧化碳中毒迟发性脑病的预测价值。方法采用前瞻性观察性研究方法，选择2013年11月至2016年3月收治的急性重度一氧化碳中毒患者，记录患者的基线特征及生理学参数，以急性中毒后2月为观察终点，根据是否发生迟发性脑病分为迟发性脑病组21例及无迟发性脑病组64例。连续监测入院时、6、24、48、72 h O2UCc的变化，采用Spearman相关检验对O2UCc与APACHEⅡ评分进行相关性分析，采用受试者工作特征曲线（ROC）评价O2UCc预测迟发性脑病的准确性。结果两组患者入院时O2UC均明显升高，且以迟发性脑病组升高明显，差异有统计学意义（P〈0.05），之后两组均呈现下降趋势，6、24、48 h迟发性脑病组O2UC均高于无迟发性脑病组（迟发性脑病组分别为52.57%±9.30%、47.40%±7.92%、39.38%±8.01%、32.29%±6.31%，无迟发性脑病组分别为41.46±%6.37%、34.51%±7.89%、28.79%±5.4%、27.72%±5.46%），差异有统计学意义（P〈0.05）；入院时、6、24、48 h O2UCc与APACHEⅡ评分呈正相关（r初始、r6 h、r24 h、r48 h分别为0.304、0.398、0.426，0.300，均P〈0.01）；ROC曲线分析结果显示，O2UCc初始、6、24、48 h均对DEACMP有预测价值，以6 h O2UCc预测价值最大，AUC为0.870，95% CI为0.794~0.947（P〈0.05）。结论O2UCc的动态变化对迟发性脑病的早期预检有参考意义，O2UCc可以作为预测迟发性脑病发生的参考指标。ObjectiveTo investigate the dynamic change in cerebral oxygen utilization coefficient （O2UCc） in the early stage of acute severe carbon monoxide poisoning （ASCMP） and its value in predicting delayed encephalopathy after acute carbon monoxide poisoning （DEACMP） .MethodsA prospective observational study was conducted for patients with ASCMP who were admitted to our hospital from November 2013 to March 2016, and their baseline features and physiological parameters were recorded. Observation ended at two months after acute poisoning; according to the presence or absence of DEACMP, the patients were divided into DEACMP group with 21 patients and non-DEACMP group with 64 patients. The change in O2UCc was monitored on admission and at 6, 24, 48, and 72 hours. Spearman correlation was used to investigate the correlation between O2UCc and Acute Physiology and Chronic Health Evaluation II （APACHE II） score, and the receiver operating characteristic （ROC） curve was used to evaluate the accuracy of O2UCc in predicting DEACMP.ResultsBoth groups had a significant increase in O2UCc on admission, and the DEACMP group had a significantly greater increase than the non-DEACMP group （52.57%±9.30% vs 41.46±%6.37%, P〈0.05） . Then both groups tended to have a reduction in O2UCc, and the DEACMP group had a significantly higher O2UCc than the non-DEACMP group at 6, 24, and 48 hours （47.40%±7.92%, 39.38%±8.01%, and 32.29%±6.31% vs 34.51%±7.89%, 28.79%±5.4%, and 27.72%±5.46%, P〈0.05） . On admission and at 6, 24, and 48 hours, O2UCc was positively correlated with APACHE II score （r=0.304, 0.398, 0.426, and 0.300, P=0.005, 0.000, 0.000, and 0.005） . The ROC curve showed that O2UCc had a value in predicting DEACMP on admission and at 6, 24, and 48 hours, and 6-hour O2UCc had the highest predictive value with an area under the ROC curve of 0.870 （95% confidence interval 0.794-0.947, P〈0.05） .ConclusionThe dynamic change in O2UCc has a reference value in early identification of DEACMP, and O2UCc

关 键 词：一氧化碳中毒 迟发性脑病 脑氧利用率 预测 

分 类 号：R595.1[医药卫生—内科学] R747.9[医药卫生—临床医学]