急性有机磷中毒患者不同心电图改变对其预后预测价值的研究

The predictive value of the electrocardiographic changes in determining short-term prognosis after intentional organophosphate poisoning

目的 研究急性有机磷中毒患者不同心电图改变及对其预后的预测价值.方法 入选河南省人民医院103例急性口服有机磷中毒患者,入院时及入院24 h分别行心电图检查,对比两次心电图变化特征,应用统计学方法分析不同心电图变化对其预后的预测价值.结果 对入选的103例急性有机磷中毒患者临床资料进行分析发现,PR间期与急性呼吸衰竭发生率之间比较差异有统计学意义,年龄和QTc间期与死亡及急性呼吸衰竭发生率差异均有统计学意义.入院24 h后QTc均较入院时延长.血胆碱酯酶（CHE）、QTc和两次QTc之差（△QTc）对急性呼吸衰竭发生率受试者工作特征曲线（ROC）下面积分别为：0.033 （95％ CI：0.004～0.063）,0.829（95％CI：0.739 ～0.918）和0.943 （95％ CI：0.888 ～0.998）;CHE、QTc和△QTc对病死率ROC曲线下面积分别为：0.052（95％ CI：0.01 ～0.094）,0.693 （95％ CI：0.559 ～0.826）和0.895 （95％ CI：0.814～0.977）.结论 △QTc可能作为新的、更好的预测急性口服有机磷中毒患者短期预后的指标.

Objective To study the value of the different electrocardiographic changes in acute organophosphate poisoning.Methods A total of 103 patients with acute organophosphate （OP） poisoning were included and their relevant ECG abnormalities were investigated.ECG recordings were taken on arrival at the emergency department and 24 hours after admission.ECG analysis included heart rate,ST-T abnormalities,conduction defects,measurement of PR and QTc intervals,and the difference in QTc intervals between two ECG readings （△QTc）.The correlation was assessed between ECG changes and the severity of poisoning.Results QTc and age were significant risk factors for respiratory failure and mortality.PR was significant risk factor for respiratory failure.The prolonged QTc interval was found in 100% of patients 24 hours after poisoning.The area under receiver operating characteristic （ROC） curves of the blood cholinesterase activity （CHE）,QTc and △QTc for respiratory failure were 0.033 （95% CI：0.004-0.063）,0.829 （95 % CI：0.739-0.918） and 0.943 （95% CI：0.888-0.998） respectively.And the area under ROC curves of the CHE,QTc and △QTc for death were 0.052 （95% CI：0.01-0.094）,0.693 （95% CI：0.559-0.826） and 0.895 （95% CI：0.814-0.977） respectively.Conclusions The△QTc may be a novel and better predictive factor for determining short-term prognosis after intentional organophosphate poisoning.