摘要
目的:探讨动静脉二氧化碳分压差/动静脉氧含量差[P(v-a)CO_(2)/C(a-v)O_(2)]对急性有机磷中毒患者预后的预测价值。方法:选取我院111例有机磷农药中毒患者,按P(v-a)CO_(2)/C(a-v)O_(2)治疗后变化分为下降组(n=54)和上升组(n=57)。比较两组的一般资料、并发症、氧代谢相关指标以及预后,分析氧代谢指标对预后的价值。结果:与下降组相比,上升组休克、重要器官损伤以及中间综合征发生率明显升高,同时胆碱酯酶恢复正常、意识恢复及机械通气时间延长,阿托品用量明显升高,病死率亦升高。两组乳酸在治疗前后比较差异均有统计学意义(P<0.05)。两组的P(v-a)CO_(2)/C(a-v)O_(2)治疗前比较差异无统计学意义,治疗后上升组P(v-a)CO_(2)/C(a-v)O_(2)明显高于下降组。Logistic回归分析显示,乳酸是治疗前患者的死亡危险因素(P<0.05),P(v-a)CO_(2)/C(a-v)O_(2)和乳酸是急性有机磷中毒治疗后的死亡危险因素。进一步ROC曲线发现,治疗前后均是P(v-a)CO_(2)/C(a-v)O_(2)对急性有机磷中毒患者死亡预测价值最高,曲线下面积及最佳诊断界值为分别为0.840、2.45以及0.861、2.55。结论:氧代谢相关指标与急性有机磷中毒患者预后密切相关,其中P(v-a)CO_(2)/C(a-v)O_(2)是评估预后不良的较好指标。
Objective: To investigate the predictive value of P(v-a) CO_(2)/C(a-v) O_(2) in patients with acute organophosphorus poisoning. Methods: A total of 111 patients were selected. After the treatment, according to whether P(v-a) CO_(2)/C(a-v) O_(2) increased or not, the patient were divided into increase group(n=57) and decrease group(n=54). General clinical date, incidences of organ dysfunction and complications, clinical prognosis, and oxygen metabolism indexes were compared between the two groups and the predictive value of oxygen metabolism indexes in mortality was evaluated. Results: The incidences of shock, complications and intermediate syndromein the increase group were significantly higher than those in the decrease group(P<0.05). Meanwhile, there were significant differences in serum cholinesterase recovery time, coma duration, duration of mechanical ventilation, atropine dosage and mortality between two groups(P<0.05). Before the treatment, no significant difference were found in P(v-a) CO_(2)/C(a-v) O_(2) between two groups. However, P(v-a) CO_(2)/C(a-v) O_(2) was significantly higher in increase group than that in decrease group after the treatment. There was significant difference in lactic acid between the two groups before and after the treatment(P<0.05). Multivariate logistic regression analysis showed that before the treatment lactic acid was the risk factor of hospital mortality. After the treatment, lactic acid and P(v-a) CO_(2)/C(a-v) O_(2) were the risk factors of hospital mortality. ROC curve indicated that P(v-a) CO_(2)/C(a-v) O_(2) showed the highest predictive value for mortality in both before and after the treatment(P<0.05). Area under the curve and optimal diagnostic boundary value is respectively 0.840, 2.45 and 0.861, 2.55. Conclusion: Oxygen metabolism index was associated with prognosis of patients with organophosphorus poisoning. Additionally, P(v-a) CO_(2)/C(a-v) O_(2) could be used as a potential index to evaluate the prognosis of acute organophosphorus poisoning.
作者
崔文华
韩翡
宋林超
张仕娟
CUI Wenhua;HAN Fei;SONG Linchao;ZHANG Shijuan(Department of Critical Care Medicine,Weifang Yidu Central Hospital,Weifang,Shandong,262500,China)
出处
《临床急诊杂志》
CAS
2021年第10期663-666,共4页
Journal of Clinical Emergency
