急性重度有机磷农药中毒患者早期临床指标与预后相关性的研究
发布时间：2018-09-05 08:24
【摘要】：目的:探讨急性重度有机磷农药中毒(acute severe organophosphorus pesticide poisoning,ASOPP)患者的早期临床指标与预后的相关性,为ASOPP的治疗和预后判断提供参考。方法:选取2014年1月至2016年12月间就诊于吉林大学第一医院二部急救医学科的急性有机磷农药中毒(acute organophosphorus pesticide poisoning,AOPP)患者213例。根据纳入与排除标准筛选得到符合研究标准的ASOPP患者130例,收集患者的预后、性别、年龄、服药剂量、服药种类、服药至洗胃时间、是否血液灌流治疗(HP),入院即刻的血常规、胆碱酯酶、血糖、丙氨酸氨基转移酶(ALT)、总胆红素(TBIL)、肌酐(CRE)、尿素氮(BUN)、肌酸激酶同工酶、血淀粉酶、动脉血酸碱度(PH)、动脉血乳酸(Lac)、动脉血氧分压(Pa O2)、动脉血二氧化碳分压(Pa CO2)、动脉血碳酸氢根(HCO3-)、血钙检测结果,记录脏器损害的种类和数目、格拉斯哥昏迷指数(GCS)评分及急性生理与慢性健康评分II(APACHE II)的临床资料。根据预后将患者分为存活组(n=107)与死亡组(n=23),应用单因素分析比较两组上述指标的差异,应用Spearman相关分析分析经单因素分析后差异有统计学意义的指标与预后的相关程度,将与预后相关程度强的指标绘制成受试者工作特征曲线(ROC曲线),用以评估各指标对ASOPP患者预后的预测价值。结果:(1)130例ASOPP患者中,存活107例,死亡23例,病死率17.69%,男性61例(46.9%),女性69例(53.1%),男:女=0.88:1;存活组男性47例(43.9%),女性60例(56.1%),死亡组男性14例(60.9%),女性9例(39.1%),两组性别比较差异无统计学意义(P0.05);两组患者年龄在14~84岁之间,平均年龄47.21±16.50岁,中毒人群中以青年人居多58例(44.62%),中毒死亡人群中以老年人居多13例(56.52%);死亡组平均年龄58±18.638岁,存活组平均年龄44.89±15.121岁,两组年龄比较差异有显著性统计学意义(P0.01);(2)130例ASOPP患者,服药剂量在10~500ml之间,平均服药剂量102.19±88.388ml;存活组的服药剂量为50(50,100)ml,死亡组的服药剂量为100(100,250)ml,死亡组的服药剂量多于存活组,两组比较差异有显著性统计学意义(P0.01);(3)死亡组的服药至洗胃时间长于存活组,HP所占比例低于存活组,两组比较差异均有显著性统计学意义(均P0.01);(4)入院即刻的实验室检查中,死亡组的胆碱酯酶、血钙、PH、Pa O2、HCO3-水平均低于存活组,两组比较差异均有显著性统计学意义(均P0.01);死亡组的血糖、ALT、CRE、血淀粉酶、肌酸激酶同工酶、Lac、Pa CO2水平均高于存活组,两组比较差异均有统计学意义(均P0.05);(5)死亡组的GCS评分明显低于存活组,APACHE II评分高于存活组,两组比较差异均有显著性统计学意义(均P0.01);(6)ASOPP时,损害的主要脏器种类包括脑、肺、心脏、循环、肝脏、肾、胰腺、胃肠道,以脑、肺、心脏最常受累,其次为胰腺;存活组脏器损害发生率由高到低的脏器种类为:脑、肺、胰腺、心脏、肝脏、循环、肾,死亡组脏器损害发生率由高到低的脏器种类为:脑、心脏、肺、胃肠道、循环、胰腺、肝脏、肾;两组胰腺损害的发生率差异无统计学意义(P0.05),余脏器损害发生率死亡组均高于存活组,两组比较差异均有显著性统计学意义(均P0.01);死亡组早期同时出现脏器损害的个数为4(4,5)个,明显高于存活组的脏器损害数目1(0,1)个,两组比较差异有显著性统计学意义(P0.01);(7)Spearman相关分析提示与预后相关性强(相关系数r的绝对值0.4)的指标为血糖(r=0.417)、血钙(r=-0.415)、PH(r=-0.469)、Lac(r=0.469)、Pa O2(r=-0.409)、GCS评分(r=-0.649)、APACHE II评分(r=0.592)、脏器损害数目(r=0.661),差异均有显著性统计学意义(均P0.01);其中血糖、Lac、APACHE II评分、脏器损害数目均与预后呈正相关,血钙、PH、Pa O2、GCS评分均与预后呈负相关;(8)用于评估各指标对ASOPP患者预后的预测价值的ROC曲线下面积(AUC)由大到小依次为:脏器损害数目[AUC=0.981,可信区间(95%CI)=0.959~1.0,P0.01]、GCS评分[AUC=0.951,可信区间(95%CI)=0.913~0.989,P0.01]、APACHE II评分[AUC=0.947,可信区间(95%CI)=0.906~0.988,P0.01]、Lac[AUC=0.855,可信区间(95%CI)=0.781~0.928,P0.01]、PH[AUC=0.855,可信区间(95%CI)=0.752~0.958,P0.01]、血糖[AUC=0.815,可信区间(95%CI)=0.720~0.911,P0.01]、血钙[AUC=0.813,可信区间(95%CI)=0.734~0.893,P0.01]、Pa O2[AUC=0.810,可信区间(95%CI)=0.721~0.898,P0.01]。结论:(1)ASOPP时,年龄、服药剂量、服药至洗胃时间、入院即刻的胆碱酯酶、血糖、ALT、CRE、血钙、血淀粉酶、肌酸激酶同工酶、PH、Lac、Pa O2、Pa CO2、HCO3-、GCS评分、APACHE II评分、脏器损害数目为评估预后的早期预警指标;(2)经ROC曲线分析,对预后有较高预测价值的指标为脏器损害数目、GCS评分、APACHE II评分,其次为PH、Lac、血糖、血钙、Pa O2;(3)HP可降低ASOPP的病死率;(4)ASOPP时,脏器损害以脑、肺、心脏最常受累,死亡组脏器损害的发生率较高。
[Abstract]:Objective: To investigate the correlation between early clinical parameters and prognosis in patients with acute severe organophosphorus pesticide poisoning (ASOPP), and to provide reference for the treatment and prognosis of ASOPP. 213 patients with acute organophosphorus pesticide poisoning (AOPP) were selected according to inclusion and exclusion criteria. 130 patients with ASOPP were selected according to inclusion and exclusion criteria. Regular, cholinesterase, blood glucose, alanine aminotransferase (ALT), total bilirubin (TBIL), creatinine (CRE), urea nitrogen (BUN), creatine kinase isozyme, blood amylase, arterial acidity (PH), arterial lactic acid (Lac), arterial partial pressure of oxygen (PaO 2), arterial partial pressure of carbon dioxide (PaCO 2), arterial bicarbonate (HCO 3 -), blood calcium test results were recorded. Types and number of organ damage, Glasgow Coma Index (GCS) score, and Acute Physiological and Chronic Health Score II (APACHE II) clinical data. Patients were divided into survival group (n = 107) and death group (n = 23) according to prognosis. The differences of the above indexes between the two groups were compared by univariate analysis and Spearman correlation analysis. Results: (1) Among 130 ASOPP patients, 107 survived, 23 died, the mortality was 17.69%, 61 males (46.9%) and 69 females (69%). There were 47 males (43.9%) and 60 females (56.1%) in the survival group, 14 males (60.9%) and 9 females (39.1%) in the death group. There was no significant gender difference between the two groups (P 0.05). The age of the two groups was between 14 and 84 years old, with an average age of 47.21 [16.50 years old]. There were 58 cases (44.62%) in the poisoning group and 58 cases (44.62%) in the poisoning death group. 13 cases (56.52%) were elderly, the average age of death group was 58 (+ 18.638) years, the average age of survival group was 44.89 (+ 15.121) years, the difference between the two groups was statistically significant (P 0.01); (2) 130 cases of ASOPP patients, the dosage of medication was 10-500 ml, the average dosage of medication was 102.19 (+ 88.388 ml); the dosage of medication of survival group was 50 (50, 100) ml, and the death rate was 50 (50, 100) ml). The dosage of HP in the death group was 100 (100,250) ml, and the dosage of HP in the death group was more than that in the survival group, the difference was statistically significant (P 0.01); (3) The time from taking medicine to gastric lavage in the death group was longer than that in the survival group, and the proportion of HP in the survival group was lower than that in the survival group, the difference between the two groups was statistically significant (P 0.01); (4) The laboratory immediately after admission was significantly different (P 0.01). During the examination, the levels of cholinesterase, serum calcium, PH, PaO 2, HCO 3 - in the death group were lower than those in the survival group, and the differences between the two groups were statistically significant (all P 0.01); the levels of blood glucose, ALT, CRE, blood amylase, creatine kinase isoenzyme, Lac, PaCO 2 in the death group were higher than those in the survival group, and the differences between the two groups were statistically significant (all P 0.05); (5) The levels of blood glucose, ALT, CRE, creatine kinase isoenzyme The GCS score of ASOPP group was significantly lower than that of the survival group, APACHE II score was higher than that of the survival group, and there was significant difference between the two groups (all P 0.01); (6) When ASOPP, the main types of organ damage included brain, lung, heart, circulation, liver, kidney, pancreas, gastrointestinal tract, brain, lung, heart most frequently involved, followed by pancreas; the incidence of organ damage in the survival group was due to pancreas. The types of organs from high to low were brain, lung, pancreas, heart, liver, circulation, kidney and death group, the incidence of organ damage from high to low were brain, heart, lung, gastrointestinal tract, circulation, pancreas, liver, kidney; the incidence of pancreas damage was not statistically significant between the two groups (P 0.05). The incidence of residual organ damage in death group was higher than that in survival group. There were significant differences between the two groups (all P 0.01); the number of early simultaneous organ damage in the death group was 4 (4,5), which was significantly higher than that in the survival group (0,1), and there was significant difference between the two groups (P 0.01); (7) Spearman correlation analysis indicated a strong correlation with prognosis (absolute value of correlation coefficient R 0.4). Blood glucose (r = 0.417), serum calcium (r = - 0.415), PH (r = - 0.469), Lac (r = 0.469), PaO 2 (r = - 0.409), GCS score (r = - 0.649), APACHE II score (r = - 0.592), organ damage number (r = 0.661), the differences were statistically significant (all P 0.01); blood glucose, Lac, APACHE II score, organ damage number were positively correlated with prognosis, blood calcium, PH, PHO 2, and organ damage number. GCS scores were negatively correlated with prognosis; (8) The area under the ROC curve (AUC) used to evaluate the prognostic value of each index for ASOPP patients was in turn the number of organ damage [AUC = 0.981, confidence interval (95% CI) = 0.959-1.0, P 0.01], GCS score [AUC = 0.951, confidence interval (95% CI) = 0.913-0.989, P 0.01], APACHE II score [AUC = 0.947, P 0.947, P 0.01]. 鍖洪棿(95%CI)=0.906~0.988,P0.01],Lac[AUC=0.855,鍙俊鍖洪棿(95%CI)=0.781~0.928,P0.01],PH[AUC=0.855,鍙俊鍖洪棿(95%CI)=0.752~0.958,P0.01],琛，
本文编号：2223726
[Abstract]:Objective: To investigate the correlation between early clinical parameters and prognosis in patients with acute severe organophosphorus pesticide poisoning (ASOPP), and to provide reference for the treatment and prognosis of ASOPP. 213 patients with acute organophosphorus pesticide poisoning (AOPP) were selected according to inclusion and exclusion criteria. 130 patients with ASOPP were selected according to inclusion and exclusion criteria. Regular, cholinesterase, blood glucose, alanine aminotransferase (ALT), total bilirubin (TBIL), creatinine (CRE), urea nitrogen (BUN), creatine kinase isozyme, blood amylase, arterial acidity (PH), arterial lactic acid (Lac), arterial partial pressure of oxygen (PaO 2), arterial partial pressure of carbon dioxide (PaCO 2), arterial bicarbonate (HCO 3 -), blood calcium test results were recorded. Types and number of organ damage, Glasgow Coma Index (GCS) score, and Acute Physiological and Chronic Health Score II (APACHE II) clinical data. Patients were divided into survival group (n = 107) and death group (n = 23) according to prognosis. The differences of the above indexes between the two groups were compared by univariate analysis and Spearman correlation analysis. Results: (1) Among 130 ASOPP patients, 107 survived, 23 died, the mortality was 17.69%, 61 males (46.9%) and 69 females (69%). There were 47 males (43.9%) and 60 females (56.1%) in the survival group, 14 males (60.9%) and 9 females (39.1%) in the death group. There was no significant gender difference between the two groups (P 0.05). The age of the two groups was between 14 and 84 years old, with an average age of 47.21 [16.50 years old]. There were 58 cases (44.62%) in the poisoning group and 58 cases (44.62%) in the poisoning death group. 13 cases (56.52%) were elderly, the average age of death group was 58 (+ 18.638) years, the average age of survival group was 44.89 (+ 15.121) years, the difference between the two groups was statistically significant (P 0.01); (2) 130 cases of ASOPP patients, the dosage of medication was 10-500 ml, the average dosage of medication was 102.19 (+ 88.388 ml); the dosage of medication of survival group was 50 (50, 100) ml, and the death rate was 50 (50, 100) ml). The dosage of HP in the death group was 100 (100,250) ml, and the dosage of HP in the death group was more than that in the survival group, the difference was statistically significant (P 0.01); (3) The time from taking medicine to gastric lavage in the death group was longer than that in the survival group, and the proportion of HP in the survival group was lower than that in the survival group, the difference between the two groups was statistically significant (P 0.01); (4) The laboratory immediately after admission was significantly different (P 0.01). During the examination, the levels of cholinesterase, serum calcium, PH, PaO 2, HCO 3 - in the death group were lower than those in the survival group, and the differences between the two groups were statistically significant (all P 0.01); the levels of blood glucose, ALT, CRE, blood amylase, creatine kinase isoenzyme, Lac, PaCO 2 in the death group were higher than those in the survival group, and the differences between the two groups were statistically significant (all P 0.05); (5) The levels of blood glucose, ALT, CRE, creatine kinase isoenzyme The GCS score of ASOPP group was significantly lower than that of the survival group, APACHE II score was higher than that of the survival group, and there was significant difference between the two groups (all P 0.01); (6) When ASOPP, the main types of organ damage included brain, lung, heart, circulation, liver, kidney, pancreas, gastrointestinal tract, brain, lung, heart most frequently involved, followed by pancreas; the incidence of organ damage in the survival group was due to pancreas. The types of organs from high to low were brain, lung, pancreas, heart, liver, circulation, kidney and death group, the incidence of organ damage from high to low were brain, heart, lung, gastrointestinal tract, circulation, pancreas, liver, kidney; the incidence of pancreas damage was not statistically significant between the two groups (P 0.05). The incidence of residual organ damage in death group was higher than that in survival group. There were significant differences between the two groups (all P 0.01); the number of early simultaneous organ damage in the death group was 4 (4,5), which was significantly higher than that in the survival group (0,1), and there was significant difference between the two groups (P 0.01); (7) Spearman correlation analysis indicated a strong correlation with prognosis (absolute value of correlation coefficient R 0.4). Blood glucose (r = 0.417), serum calcium (r = - 0.415), PH (r = - 0.469), Lac (r = 0.469), PaO 2 (r = - 0.409), GCS score (r = - 0.649), APACHE II score (r = - 0.592), organ damage number (r = 0.661), the differences were statistically significant (all P 0.01); blood glucose, Lac, APACHE II score, organ damage number were positively correlated with prognosis, blood calcium, PH, PHO 2, and organ damage number. GCS scores were negatively correlated with prognosis; (8) The area under the ROC curve (AUC) used to evaluate the prognostic value of each index for ASOPP patients was in turn the number of organ damage [AUC = 0.981, confidence interval (95% CI) = 0.959-1.0, P 0.01], GCS score [AUC = 0.951, confidence interval (95% CI) = 0.913-0.989, P 0.01], APACHE II score [AUC = 0.947, P 0.947, P 0.01]. 鍖洪棿(95%CI)=0.906~0.988,P0.01],Lac[AUC=0.855,鍙俊鍖洪棿(95%CI)=0.781~0.928,P0.01],PH[AUC=0.855,鍙俊鍖洪棿(95%CI)=0.752~0.958,P0.01],琛，
本文编号：2223726
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