动脉血HCO_(3)^(-)早期变化对急性百草枯中毒的预后价值  

Prognostic value of early changes in arterial blood level of bicarbonate ion for acute paraquat poisoning

作　　者：李广珍 苏艺伟 方文馨 刘移民[1] 唐侍豪 王致[1] LI Guangzhen;SU Yiwei;FANG Wenxin;LIU Yimin;TANG Shihao;WANG Zhi(Laboratory of Occupational Environment and Health,Guangzhou Manicipal Twelfth People's Hospital/Guangzhou Occupational Disease Prevention and Treatment Hospital,Guangzhou,Guangdong 510620,China;Department of Public Health and Preventive Medicine,School of Medicine of Jinan University,Guangzhou,Guangdong 510632,China)

机构地区：[1]广州市第十二人民医院/广州市职业病防治所职业环境与健康重点实验室,广东广州510620 [2]暨南大学基础医学与公共卫生学院公共卫生预防医学系

出　　处：《中国工业医学杂志》2024年第2期123-126,137,共5页Chinese Journal of Industrial Medicine

基　　金：广东省基础与应用基础研究基金联合基金项目(编号:2021A1515110663);广州市科学技术局市校(院)企联合资助项目(编号:2023A03J0977);广州市科学技术局重点研发计划项目(编号:202206010061);广州市医学重点学科建设项目(2021—2023年)。

摘　　要：目的 探索中毒早期患者动脉血碳酸氢根离子(HCO_(3)^(-))变化情况与急性百草枯(PQ)中毒死亡风险的关系。方法 采用回顾性研究方法,收集2009年1月—2022年1月在广州市第十二人民医院住院治疗且符合研究条件的109例急性PQ中毒患者的临床资料,根据患者中毒后60 d的随访结局,将研究对象分为生存组(54例)和死亡组(55例);通过潜类别轨迹模型分析患者中毒后3 d内动脉血HCO_(3)^(-)变化趋势,采用单因素分析与二元Logistic回归方法评估动脉血HCO_(3)^(-)动态变化轨迹,探索其对预测急性PQ患者死亡风险的价值。结果 急性PQ中毒患者动脉血HCO_(3)^(-)动态变化有平稳轨迹(73例,66.97%)和升高轨迹(36例,33.03%)两种类型。死亡组患者HCO_(3)^(-)变化轨迹类型、性别、呕吐发生率、血液净化率与生存组相比,差异有统计学意义(P<0.05)。二元Logistic回归分析显示,患者性别、PQ摄入量、动脉血HCO_(3)^(-)变化轨迹是急性PQ中毒患者死亡的独立危险因素(OR>1,P<0.05),中毒后3 d内患者动脉血HCO_(3)^(-)变化为平稳轨迹者发生死亡的风险是升高轨迹者的4.434倍(P<0.05);预测模型准确率70.64%,特异度75.93%,敏感度65.45%。结论 中毒早期动脉血HCO3-的变化趋势有助于判断急性PQ中毒的预后,患者中毒后3 d内HCO_(3)^(-)持续低值常预示中毒结局不良。Objective To explore the association between the early change trend of arterial blood bicarbonate ion(HCO_(3)^(-))and the risk of death in patients with acute paraquat(PQ)poisoning.Methods Using a retrospective study method,the data of 109 patients with acute paraquat poisoning who were hospitalized in the Municipal 12th People's Hospital of Guangzhou from January 2009 to January 2022 who met the reseach criteria were included the study,based on the follow-up results of 60 days after poisoning,the study subjects were divided into a survival group(54 cases)and a death group(55 cases),analyze the trend of arterial blood bicarbonate changes within three days after poisoning using a latent category trajectory model,then evaluate the dynamic trajectory of arterial blood bicarbonate changes using univariate analysis and binary Logistic regression methods,and explore its value in predicting the risk of death in patients with acute paraquat poisoning.Results The results showed that there were two types of change trends in arterial blood bicarbonate levels:stable trajectory(73 cases,66.97%)and elevated trajectory(36 cases,33.03%),the type of change in blood bicarbonate level,gender,incidence of vomiting and ratio of using blood purification in death group were statistically significant compared with survival group(P<0.05).The binary Logistic regression analysis showed that the patient gender,intake amount of PQ,and the change type of arterial blood bicarbonate level were the independent risk factors for death of patients with acute paraquat poisoning(OR>1,P<0.05),patients with a stable arterial blood levels during the first 3 days after poisoing had a 4.434 times higher risk of death than those with an elevated type(P<0.05);the accuracy,specificity,and sensitivity of the prediction model were 70.64%,75.93%,and 65.45%,respectively.Conclusion The results suggested that change trend in arterial blood bicarbonate level in the early stage of poisoning can help detewrmine the prognosis of acute paraquat poisoning,the sustained

关 键 词：百草枯(PQ) 急性中毒 碳酸氢根离子(HCO_(3)^(-)) 轨迹分析 结局预测 

分 类 号：R595.4[医药卫生—内科学]