早期血糖水平对急性有机磷中毒患者预后评估价值的研究

The predictive value of early glucose levels for acute organophosphate poisoning patients

目的探讨早期血糖水平对急性有机磷中毒(AOPP)患者预后评估的价值。方法将63例AOPP患者依据血糖值分为正常血糖组,轻中度血糖组和重度血糖组,测定入院后血糖值并进行序贯器官衰竭评分(SOFA),比较组间多脏器功能障碍综合征(MODS)发生率、死亡率差异,分析血糖值与SOFA值的相关关系,并比较血糖值和SOFA值对死亡预测的价值。结果正常血糖组,轻中度血糖组和重度血糖组的MODS发生率依次为11.76%、26.67%、56.25%,死亡率依次为5.88%、13.33%、43.75%,3组间差异有统计学意义(P<0.05);血糖值与SOFA值存在正相关关系(r=0.853,P<0.05);3组间生存率差异有统计学意义(χ2=13.692,P<0.05);轻中度高血糖组比正常血糖组、重度高血糖组比正常血糖组、重度高血糖组比轻中度高血糖组死亡的相对危险度RR分别为3.62、12.38、3.42;SOFA评分值ROC曲线下面积为0.860(P SOFA<0.05),血糖水平的ROC曲线下面积为0.769(P血糖<0.05),两者对死亡的预测效果均有统计学意义(P<0.05)。结论血糖水平可以作为独立的预测因子来评价AOPP患者的死亡危险度。

Objective To investigate the predictive value of early glucose levels of acute organophosphate poisoning patients. Methods 63 patients with AOPP were divided into normal blood sugar group, mild to moderate hyperglycemia group and severe hyper- glycemia group based on blood glucose levels, measured the blood glucose levels and SOFA score after admission, incidence of MODS and mortality were compared between groups, analyzed the correlation value between blood glucose levels and SOFA score, and compared the prediction value of death between glucose value and SOFA value. Results The incidence of MODS in the normal glucose group,mild to moderate hyperglycemia group and severe hyperglycemia group were respectively 11.76% , 26.67% and 56.25% , and mortality rates were respectively 5.88% , 13.33% and 43.75% , there were statistically significant differences among the three groups （ P 〈 0.05 ） ; blood sugar value and SOFA values were positively correlated （ r = 0. 853, P 〈 0.05 ） ; there were statistically significant difference in survival among the three groups （ X2 = 13. 692, P 〈 0.05 ） , for mild hyperglycemia group to normal glucose group, severe high blood glu- cose group to normal blood glucose,severe hyperglycemia group to mild hyperglycemia group,the death relative risk （RR） were respectively 3.62,12.38 and 3.42 ; ROC area under the curve of SOFA score was 0. 860, PSOFA 〈 0. 05, ROC area under the curve of the blood glucose level was O. 769, Pglucose 〈 0.05 ,the effect of predictors of death of two groups were statistically significant, but between groups Z = 0. 9579,P 〉 0.05. Conclusion The blood glucose levels can be used as an independent predictor of AOPP to evaluate the risk of death.