早期血液检测指标变化值对急性百草枯中毒患者预后的预测价值  

Predictive value of early indicators changes in blood test on the prognosis of patients with acute paraquat poisoning

作　　者：晁琳琳 刘振宁[1] 赵敏[1] 杨梦莹 叶永壮 魏贵贵 Chao Linlin;Liu Zhenning;Zhao Min;Yang Mengying;Ye Yongzhuang;Wei Guigui(Department of Emergency,Shengjing Hospital of China Medical University,Shenyang 110004,Liaoning,China)

机构地区：[1]中国医科大学附属盛京医院急诊科,沈阳110004

出　　处：《中华危重病急救医学》2020年第6期732-736,共5页Chinese Critical Care Medicine

基　　金：辽宁省科技厅重点研发计划项目(2018225095)。

摘　　要：目的探讨早期血液检测指标变化值对急性百草枯中毒患者预后的预测价值。方法回顾性分析2012年1月至2019年6月中国医科大学附属盛京医院急诊科收治的急性百草枯中毒患者的临床资料。收集患者入院24 h内血液检测指标变化值,包括白细胞计数(ΔWBC)、中性粒细胞绝对值(ΔNE)、淋巴细胞绝对值(ΔLY)、单核细胞绝对值(ΔMO)、动脉血氧分压(ΔPaO2)、动脉血二氧化碳分压(ΔPaCO2)、动脉血pH值(ΔpH)、HCO^-3(ΔHCO^-3)、剩余碱(ΔBE)、血乳酸(ΔLac)、总蛋白(ΔTP)、白蛋白(ΔALB)、丙氨酸转氨酶(ΔALT)、天冬氨酸转氨酶(ΔAST)、总胆红素(ΔTBil)、直接胆红素(ΔDBil)、血尿素氮(ΔBUN)、血清肌酐(ΔSCr)、血清钙离子(ΔCa^2+)、血清钾离子(ΔK^+);运用多因素Logistic回归分析急性百草枯中毒患者预后的危险因素,并对危险因素绘制受试者工作特征曲线(ROC),分析其对百草枯中毒患者死亡的预测价值。结果共纳入251例急性百草枯中毒患者,死亡99例,病死率为39.4%。死亡组入院24 h内ΔWBC、ΔLac、ΔALT、ΔAST、ΔTBil、ΔDBil、ΔBUN、ΔSCr及ΔK^+升高幅度均显著大于存活组,而ΔPaCO2、ΔHCO^-3、ΔBE、ΔTP及ΔALB下降幅度均显著大于存活组。将上述单因素分析中差异有统计学意义的变量纳入多因素Logistic回归分析,结果显示ΔLac、ΔSCr及ΔK^+是影响急性百草枯中毒患者预后的独立危险因素〔优势比(OR)和95%可信区间(95%CI)分别为1.662(0.997~2.772)、1.045(1.010~1.083)和4.555(1.190~17.429),均P<0.05〕。ROC曲线分析显示,ΔLac、ΔSCr及ΔK^+预测急性百草枯中毒患者死亡的ROC曲线下面积(AUC)分别为0.639(95%CI为0.505~0773)、0.811(95%CI为0.704~0.917)和0.649(95%CI为0.519~0.779)。当ΔLac最佳临界值为1.85 mmol/L时,敏感度为87.9%,特异度为47.7%,诊断准确率为70.2%;当ΔSCr最佳临界值为37.75μmol/L时,敏感度为84.4%,特异度为77.9%,诊断准确率为80.5%;当ΔK^+最佳临界值�Objective To investigate the predictive value of early indicators changes in blood test on the prognosis of patients with acute paraquat poisoning.Methods The clinical data of patients with acute paraquat poisoning admitted to emergency department of Shengjing Hospital of China Medical University from January 2012 to June 2019 were retrospectively analyzed.The changes of blood test indexes within 24 hours after admission were collected,including white blood cell count(ΔWBC),neutrophils count(ΔNE),lymphocytes count(ΔLY),monocytes count(ΔMO),arterial partial pressure of oxygen(ΔPaO2),arterial partial pressure of carbon dioxide(ΔPaCO2),arterial blood pH(ΔpH),bicarbonate radical(ΔHCO^-3),base excess(ΔBE),lactate(ΔLac),total protein(ΔTP),albumin(ΔALB),alanine aminotransferase(ΔALT),aspartate aminotransferase(ΔAST),total bilirubin(ΔTBil),direct bilirubin(ΔDBil),blood urea nitrogen(ΔBUN),serum creatinine(ΔSCr),serum calcium concentration(ΔCa^2+),and serum potassium concentration(ΔK^+).Multivariate Logistic regression was used to analyze the risk factors of prognosis in patients with acute paraquat poisoning,and receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of ROC curve for the death of patients with paraquat poisoning.Results A total of 251 patients with acute paraquat poisoning were included,with 99 cases dead,and the mortality was 39.4%.The increase of the markers includingΔWBC,ΔLac,ΔALT,ΔAST,ΔTBil,ΔDBil,ΔBUN,ΔSCr andΔK^+within 24 hours of admission in the death group were significantly higher than that in the survival group;the decrease of the markers includingΔPaCO2,ΔHCO^-3,ΔBE,ΔTP,andΔALB in the death group were significantly greater than those in the survival group.The variables with statistical significance in the above single factor analysis were included in the multivariate Logistic regression analysis.The results showed thatΔLac,ΔSCr andΔK^+were independent risk factors for the prognosis of patients with acute paraquat poisoning[odds

关 键 词：中毒 百草枯 血清肌酐 钾离子 乳酸 预后 

分 类 号：R595.4[医药卫生—内科学]