早期血糖水平和序贯器官衰竭评分对急性百草枯中毒患者的预后评估

Early Blood Glucose and SOFA Score for Prognostic Assessment of Acute Paraquat Poisoning Patients

目的探讨急性百草枯中毒(APP)的预后因素。方法分析31例APP患者早期血糖和序贯器官衰竭评分(SOFA评分)与2周内病死的关系。结果 APP 2周内病死患者第1、3天血糖及前3 d平均血糖(第1、3天血糖的均值)和第1、3天的SOFA评分均明显高于存活者(P<0.05)。第1、3天血糖及前3 d平均血糖均与2周内病死呈显著正相关(r值分别为0.684、0.721和0.724,P均<0.001)。第1、3天SOFA评分均与2周内病死显著相关(r值分别为0.608和0.525,P均<0.05)。前3 d平均血糖和第1天SOFA评分的ROC曲线下面积分别为0.960±0.037和0.884±0.059;前3 d平均血糖>12.8 mmol/L和第1天SOFA评分>8分别提示预后不良。结论第1、3天的平均血糖和第1天的SOFA评分对APP患者2周内病死具有较好的预测能力。

Objective To study the relationship between early blood glucose levels or sequential organ failure assessment （SOFA） score and the prognosis of acute paraquat poisoning （APP） patients in emergency intensive care unit （EICU）. Methods Clinical data of 31 APP patients admitted to EICU of The First Hospital of China Medical University in 2010 were recruited, and divided into the survivor group and the dead group according to the outcome within initial two weeks in EICU. SPSS17.0 was employed to analyze the relationship between early blood glucose levels or SOFA and two-week mortality. Results The blood glucose levels of the first day （Glucose-D 1 ）,the third day （Glucose- D3） and the average blood glucose levels within the initial three days （the average of the first day and the third day） （Glucose-D1-3）,as well as the SOFA scores of the first day （SOFA-D1） and the third day （SOFA-D3） in dead group were higher than these survivals （P 〈 0.05）. Glucose-D1 （r =0.684,P 〈 0.001 ） ,Glucose-D3 （r =0.721 ,P 〈 0.001 ） and Glucose-D1-3 （r =0.724,P 〈 0.001 ） were significantly positive correlated with the death in initial two weeks. SOFA-D1 （r =0.608,P 〈 0.001 ） and SOFA-D3 （r =0.525,P =0.016） were also sig- nificantly positive correlated with the death in initial two weeks. The area under ROC curves of Glucose-D1-3 or SOFA-D1 were 0.960±0.037 and 0.884±0.059, respectively. Either Glucose-D1-3 higher than 12.8 mmol/L or SOFA-D1 above 8 would give poor prognosis in ini- tial two weeks. Conclusion Glucose-D1-3 and SOFA-D1 could be employed by emergency physicians to accurately assess prognosis of APP patients.