早期动脉二氧化碳分压联合乳酸评估急性百草枯中毒患者预后的价值  

The prognostic value of arterial partial pressure of carbon dioxide combined with lactic acid in patients with acute paraquat poisoning

作　　者：晁琳琳 刘振宁[1] 贾佩佩 CHAO Linlin;LIU Zhenning;JIA Peipei(Department of Emergency Medicine,Shengjing Hospital of China Medical University,Shenyang,Liaoning,110004,China;Department of Emergency Medicine,the First People's Hospital of Zhengzhou)

机构地区：[1]中国医科大学附属盛京医院急诊科,沈阳110004 [2]郑州市第一人民医院急诊科

出　　处：《临床急诊杂志》2020年第9期683-688,共6页Journal of Clinical Emergency

基　　金：辽宁省科技厅重点研发计划项目(No:2018225095)。

摘　　要：目的:分析动脉血二氧化碳分压(PaCO2)和乳酸(Lac)水平评估急性百草枯中毒患者预后的临床价值。方法:回顾性分析2012-01—2019-06期间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。根据患者的预后分为存活组和死亡组。分析两组患者在入院即刻及24 h的临床资料,并运用Logistic回归、受试者工作特征曲线(ROC曲线)等方法研究PaCO2和Lac在百草枯中毒患者预后评估中的价值。结果:患者入院即刻的PaCO2、WBC、NE是影响急性百草枯中毒患者预后的独立危险因素,但三者AUC值均小于0.7;入院24 h时PaCO2和Lac是影响急性百草枯中毒患者预后的独立危险因素。PaCO2的AUC值为0.878,当PaCO2为26.5 mmHg;其敏感度为76.9%,特异度为92.0%,诊断准确率为81.0%。PaCO2和Lac二者联合的AUC值大于0.9,显著高于单独PaCO2的AUC值。结论:百草枯中毒患者入院24 h内PaCO2小于26.5 mmHg以及Lac大于3.2 mmol/L时,提示预后不佳。PaCO2联合Lac则可以更好的预测百草枯中毒患者的预后。Objective:To analyze the prognostic value of arterial partial pressure of carbon dioxide combined with lactic acid in patients with acute paraquat poisoning.Method: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 was retrospectively analyzed.The patients were distributed into the survival group and death group according to the outcome.The clinical data of the two groups of patients at admission and 24 h after admission was analyzed,and the prognostic values of PaCO2 and lactic acid in patients with acute paraquat poisoning were investigated using the logistic regression and receiver operating characteristic curve(ROC curve).Result:The PaCO2、WBC and NE at admission were independent risk factors for patients with acute paraquat poisoning,with all the AUC less than 0.7.The PaCO2 and lactic acid 24 h after admission were independent risk factors for patients with acute paraquat poisoning.The AUC of PaCO2 was 0.878.When PaCO2 was 26.5 mmHg,the sensitivity was 76.9%,the specificity was 92.0%,and the diagnostic accuracy is 81.0%.The AUC of PaCO2 combined with lactic acid was more than 0.9,significantly higher than that of PaCO2 alone.Conclusion:PaCO2<26.5 mmHg combined with lactic acid>3.2 mmol/L within the first 24 h after admission of the patients with acute paraquat poisoning indicates a poor prognosis.The combination of PaCO2 and lactic acid has a good prognostic value in patients with acute paraquat poisoning.

关 键 词：百草枯中毒 预后因素 动脉血二氧化碳分压 血乳酸 

分 类 号：R595.4[医药卫生—内科学]