早期监测动脉血二氧化碳分压对急性百草枯中毒患者预后的预测价值

Early Arterial Carbon Dioxide Partial Pressure Monitoring in Predicting the Outcome of Patients with Acute Paraquat Poisoning

目的探讨早期监测动脉血二氧化碳分压(PaCO2)对急性百草枯中毒患者预后的预测价值。方法回顾性分析2010年1月—2011年10月我院急诊监护室(EICU)救治的149例急性百草枯中毒患者的临床资料,观测病程早期动脉血PaCO2水平,分析其对患者预后的预测价值。结果入选患者住院期间死亡106例,病死率71.1%。死亡组患者服毒剂量、服毒-洗胃时间、服毒-血液灌流时间较存活组均明显延长,差异有统计学意义(P<0.05)。死亡组患者就诊时PaCO2和留观72 h内PaCO2最低水平较存活组均明显降低,差异有统计学意义(P<0.05)。存活组患者留观72 h内PaCO2最低值较就诊时PaCO2降低≥10 mm Hg的有6例(14.0%),与死亡组(38例,35.8%)比较差异有统计学意义(P<0.01)。患者就诊时PaCO2和留观72h内PaCO2最低水平的ROC曲线下面积(AUC)分别为0.714和0.812(P<0.05)。结论 PaCO2可能是病程早期评估急性百草枯中毒患者预后的指标之一。

Objective To explore the relationship between early arterial carbon dioxide partial pressure（PaCO2） and the outcome of patients with acute paraquat poisoning.Methods 149 patients with acute paraquat poisoning,admitted to our emergency intensive care unit（EICU） from January 2010 to October 2011 were retrospectively analyzed.The check results of early arterial PaCO2 were compared,which were used to help determine its predicting value.Results Of 149 patients,106 died during hospitalization and the mortality rate was 71.1%,who had a higher dose of paraquat,a longer time interval between exposure and gastic lavage,a longer time interval between exposure and haemoperfusion than survivors with a significant difference（P〈0.05,in all comparisons）.In non-survivors,the minimum PaCO2 value on admission and within 72 hours′ observation in hospital was obviously less than that in survivors with significant difference（P〈0.05）.There were 6 patients（14.0%） among the survivors whose PaCO2 had a decrease after 72 hours of observation in hospital than that on admission and the decreasing value of PaCO2 was above 10 mm Hg,which was significantly different than that in non-survivors（38 cases,35.8%）（P〈0.01）.The area under the ROC curve of PaCO2 on admission and the minimum PaCO2 within 72h after admission were 0.714 and 0.812（P〈0.05）,respectively.Conclusion PaCO2 may be one of early indicators for predicting the prognosis of acute paraquat poisoning.