动脉血乳酸及碱剩余对百草枯中毒预后的预测价值

Value of arterial la ctic acid and buffer excess in predicting the prognosis of patients with paraquat poisoning

目的 研究百草枯中毒患者动脉血乳酸及碱剩余的变化对预后的早期预测价值.方法 75例百草枯中毒患者分为3组,入院24h内死亡者为猝死组（10例）;入院24h后死亡者为近期死亡组（31例）;存活组34例;分别于入院时和入院后24 h测定动脉血乳酸及碱剩余.结果 入院时猝死组乳酸水平高于近期死亡组及存活组,差异有统计学意义（P＜0.01）;近期死亡组乳酸水平与存活组比较,差异无统计学意义（P=0.309）.入院时猝死组碱剩余水平低于近期死亡组及存活组,近期死亡组低于存活组,差异均有统计学意义（P＜0.01,P＜0.05）.入院后24 h近期死亡组乳酸水平明显高于存活组,碱剩余水平明显低于存活组,差异均有统计学意义（P＜0.01）.各指标与预后的Logistic回归分析均有统计学意义（P＜0.01）.入院时乳酸和碱剩余对死亡预测的ROC曲线下面积（AUC）分别是0.692和0.787,分界值为3.25和-1.75 mmol/L;对猝死预测的AUC分别是0.995和1,分界值为7.1和-12.8 mmol/L.入院后24 h乳酸和碱剩余对死亡预测的AUC分别是0.743和0.822,分界值为2.15和-5.55 mmol/L.结论 动脉血乳酸及碱剩余水平对急性百草枯中毒患者的死亡,尤其是猝死具有一定的预测价值.

Objective To investigate the early prognostic values of arterial lactate and base excess （BE） in patients with paraquat poisoning.Methods Seventy-five patients with paraquat poisoning were divided into sudden death group （n=10） who died within 24 h after admission,recent death group （n=31） who died more than 24 h after admission,and survival group （n=34）.Arterial lactate and BE were measured on admission and at 24 h after admission.The prognostic values of arterial lactate and BE were analyzed.Results The arterial lactate measured on admission was significantly higher in the sudden death group than in the recent death group and survival group （P＜0.01）,but there was no significant difference in arterial lactate between the recent death group and survival group （P=0.309）.The BE measured on admission was significantly lower in the sudden death group than in the recent death group and survival group,and it was significantly lower in the recent death group than in the survival group （P＜0.01 or P＜0.05）.At 24 h after admission,the recent death group had a significantly higher arterial lactate （P＜0.01） and a significantly lower BE （P＜0.01）,as compared with the survival group.The logistic regression analysis showed that the two indices were significantly associated with prognosis （P＜0.01）.On admission,the areas under the receiver operating characteristic （ROC） curve （AUCs） of arterial lactate and BE for predicting death were 0.692 and 0.787,respectively,and the cut-off values were 3.25 mmol/L and-1.75 mmol/L,respectively; the AUCs of arterial lactate and BE for predicting sudden death were 0.995 and 1,respectively,and the cut-off values were 7.1 mmol/L and-12.8 mmol/L,respectively.At 24 h after admission,the AUCs of arterial lactate and BE for predicting death were 0.743 and 0.822,respectively,and the cut-off values were 2.15 mmol/L and-5.55 mmol/L,respectively.Conclusion Arterial lactate and BE have certain values in predicting the death,especially the sudden death,in patients with acute paraquat poisoning.