血气分析对发作性意识障碍的鉴别诊断意义  

Value of blood gas analysis parameters in the differential diagnosis of transient disorders of consciousness

作　　者：闫中峰 夏文菁[1] 李红[1] 尹吉东 YAN Zhongfeng;XIA Wen-jing;LI Hong(Aviation General Hospital,Beijing 100012,China)

机构地区：[1]航空总医院,北京100012

出　　处：《中国实验诊断学》2020年第2期208-211,共4页Chinese Journal of Laboratory Diagnosis

摘　　要：目的探讨血气分析在急诊内科发作性意识障碍患者中的鉴别诊断价值。方法收集2015年10月至2017年12月就诊于我院急诊内科的发作性意识障碍患者140例,于发病2h内完善血气分析,分析比较血清乳酸、阴离子间隙(AG)、碳酸氢盐在全面性强直阵挛发作(GTCS)与非痫性发作中的鉴别诊断价值。结果 GTCS患者血清乳酸及AG水平显著高于复杂部分性发作、晕厥、心因性非痫性发作、非痫性发作患者(P<0.05),碳酸氢盐水平低于其他类型发作性意识障碍患者(P<0.05)。乳酸、AG和碳酸氢盐鉴别诊断GTCS与非痫性发作的曲线下面积分别为0.860(95%CI 0.785-0.935)、0.778(95%CI 0.693-0.864)、0.740(95%CI 0.633-0.848);敏感度分别为80.5%、75.6%、66.3%,特异度分别为80.2%、69.8%、65.6%。结论血清乳酸、AG、碳酸氢盐可作为GTCS与非痫性发作的早期鉴别诊断工具,其中血清乳酸诊断效能最高。Objective To investigate the value of blood gas analysis in the differential diagnosis of patients with transient disorders of consciousness in emergency department.Methods A total of 140 patients with transient disorders of consciousness who were admitted to the emergency department of our hospital from Octaber 2015 to December 2017 were enrolled.The blood gas analysis was performed within 2 hours after the onset of the disease.The serum lactate,anion gap(AG)and bicarbonate were analyzed and compared between comprehensive tonic-clonic seizures(GTCS)and non-seizures.Results Serum lactate and AG levels in patients with GTCS were significantly higher than those with complicated partial seizures,syncope,psychogenic nonepileptic seizures,and non-seizures(P<0.05)and bicarbonate levels were lower than other types of transient disorders of consciousness(P<0.05).The areas under the ROC curve for the diagnosis of GTCS and non-seizures by lactate,AG and bicarbonate were 0.860(95% CI 0.785-0.935),0.778(95% CI 0.693-0.864),and 0.740(95% CI 0.633-0.848)respectively,the sensitivities were 80.5%,75.6%,and66.3%,respectively,and the specificities were 80.2%,69.8%,and 65.6%,respectively.Conclusion Serum lactate,AG and bicarbonate can be used as early differential diagnosis tools for GTCS and non-seizure and serum lactic acid has the highest diagnostic efficiency.

关 键 词：癫痫 乳酸 阴离子间隙 碳酸氢盐 诊断标记物 

分 类 号：R741.041[医药卫生—神经病学与精神病学]