急性硫化氢中毒合并中枢神经系统损伤的相关危险因素及其预测价值研究  

Research on the related risk factors and predictive value ofacutehydrogen sulfide poisoning combined with central nervous system injury

作　　者：王瑶 张劲松 范博文 何斌 张华忠 孙昊 方熙 陈科 郭世光[4] 吴昊 WANG Yao;ZHANG Jinsong;FAN Bowen;HE Bin;ZHANG Huazhong;SUN Hao;FANG Xi;CHEN Ke;GUO Shiguang;WU Hao(Department of Emergency and Critical Care Medicine,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029;Center for Global Health,the Key Laboratory of Modern Toxicology,Ministry of Education,School of Public Health,Nanjing Medical University,Nanjing 211166;Department of Emergency,Liyang People’s Hospital,Changzhou 213300;ICU,Huai’an First Hospital Affiliated to Nanjing Medical University,Huai’an 223300,China)

机构地区：[1]南京医科大学第一附属医院急诊与危重病医学科,江苏南京210029 [2]南京医科大学公共卫生学院现代毒理学教育部重点实验室,江苏南京211166 [3]溧阳市人民医院急诊科,江苏常州213300 [4]南京医科大学附属淮安第一医院ICU,江苏淮安223300

出　　处：《南京医科大学学报（自然科学版）》2023年第12期1650-1655,1680,共7页Journal of Nanjing Medical University(Natural Sciences)

基　　金：国家自然科学基金(82272244)。

摘　　要：目的:探讨急性硫化氢(hydrogen sulfide,H2S)中毒合并中枢神经系统(central nervous system,CNS)损伤的相关风险因素及其预测价值。方法:收集2018年1月1日—2023年4月30日多家医院就诊的急性H2S中毒中至重度患者。根据是否合并CNS损伤,分析性别、年龄、实验室检验结果以及30 d的死亡、神经功能预后等,探究急性H2S中毒合并CNS损伤的相关危险因素;采用受试者工作特征(receiver operating characteristic curve,ROC)曲线分析乳酸(lactate,Lac)和神经元特异性烯醇化酶(neuron specific enolase,NSE)预测急性H2S中毒合并CNS损伤的效能。结果:与非合并CNS损伤组相比,合并CNS组H2S暴露浓度更高,入院时收缩压、中位格拉斯哥昏迷评分(Glasgow coma scale,GCS)、氧合指数均显著下降,心率显著上升。CNS损伤组入院后并发急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)、心肌损伤明显增多;30 d死亡率达50%,且改良Rankin量表>2分的患者数量显著增高。此外,通过分析发现合并CNS损伤组入院时Lac和NSE水平较非损伤组明显升高,差异均有统计学意义。ROC曲线显示联合Lac和NSE在预测急性H2S中毒合并CNS损伤的效能优于单个指标,曲线下面积(area under curve,AUC)达0.948。结论:急性H2S中毒合并CNS损伤患者并发ARDS、心肌损害增加,30 d死亡率增加和神经功能预后差;此外,急性H2S中毒联合早期血清Lac以及NSE水平的升高判断急性H2S中毒合并CNS损伤具有较高的临床价值。Objective:To explore the related risk factors and predictive value ofacute hydrogen sulfide(H2S)poisoning combined withcentral nervous system(CNS)injury.Methods:Acute H2S poisoning patients withmoderate to severe conditions who were treated in multiple hospitals from January 1,2018,to April 30,2023 were recruited.Based on whether CNS injury was present,the gender,age,laboratory test results,30⁃day mortality,and neurological function prognosis were analyzed to investigatethe relevant risk factors for acute H2S poisoning combined withCNS injury.The receiver operating characteristic(ROC)curve was used to analyze the efficacy of Lactate(Lac)and neuron⁃specific enolase(NSE)in predicting acute H2S poisoning combined with CNS injury.Results:Compared with the non⁃CNS injury group,the CNS group has higher H2S exposure concentration,significantly decreased systolic blood pressure,median glascow score and oxygenation indexupon admission,and significantly increased heart rate.The CNS injury group had a significantly higher incidence of acute respiratory distress syndrome(ARDS)and myocardial injury after admission.The30⁃day mortality rate was 50%,and the number of patients with mRS score>2 was significantly increased.In addition,the analysis found that the levels of Lac and NSE upon admission were significantly higher in the CNS group compared to the non⁃CNS injury group,and the differences were statistically significant.The ROC curve showed that the combination of Lac and NSE was more effective in predicting acute H2S poisoning combined with CNS injurythan a single index,with an area under curve(AUC)of 0.948.Conclusion:Patients with acute H2S poisoning combined with CNS injury have increased incidence of ARDS and myocardial damage,increased 30⁃day mortality rate,and poor neurological prognosis.In addition,the early elevation ofserum Lac and NSE levels has higher clinical value in evaluating acute H2S poisoning combined with CNS injury.

关 键 词：硫化氢 中毒 中枢神经系统损伤 回顾性研究 

分 类 号：R595[医药卫生—内科学]