急性百草枯中毒患者入院12h内最差生化指标与早期预后的相关性研究

Correlation between the worst biochemical index and the early prognosis in acute paraquat poisoning patients within 12 hours after admission

目的探讨急性百草枯中毒患者入院12h内相关生化指标与早期预后的相关性。方法以沧州市人民医院2009年1月至2013年8月收治的123例急性百草枯中毒患者作为研究对象,其中存活组46例,死亡组77例。记录和分析所有患者一般情况(性别、年龄)、口服百草枯剂量、入院时百草枯浓度、12h内最差急性生理与慢性健康评分Ⅱ(APACHEⅡ)评分、氢离子浓度指数(pH值)、碳酸氢根离子(HCO3-)、白细胞计数(WBC)、血钾(K+)、肌酐(Cr)等生化指标水平。比较两组患者各项指标的差异,并分析其对预后的诊断价值。结果死亡组患者12h内最差APACHEⅡ评分中位数(14分)、WBC中位数(22.06×109/L)、Cr中位数(176μmol/L)均高于存活组(3分、12.73×109/L、68μmol/L),差异均有统计学意义(P<0.05)。死亡组患者12h内pH值中位数(7.30)、HCO3-中位数(14.5mmol/L)、K+中位数(2.91mmol/L)均低于存活组(7.38、20.5mmol/L、3.41mmol/L),差异均有统计学意义(P<0.05)。死亡组患者存活时间中位数为6d(10h^35d),12h内最差APACHEⅡ评分、WBC和Cr水平与患者存活时间均呈负相关(r=-0.618、-0.824、-0.767,P<0.05);pH值和K+与患者存活时间均呈正相关(r=0.714、0.796,P<0.05)。12h内最差APACHEⅡ评分ROC曲线下面积为0.992,1-特异度为0.961,灵敏度为0.957。结论急性百草枯中毒患者入院12h内最差APACHEⅡ评分、pH值、HCO3-、WBC、K+、Cr水平与预后相关。12h内最差APACHEⅡ评分是早期判断急性百草枯中毒患者预后较可靠的指标。

Objective To investigate the correlation between biochemical indexes and the early prognosis of acute paraquat poisoning within 12 hours after admission.Methods One hundred and thirty-three patients with acute paraquat poisoning were enrolled in our hospital from January 2009 to August 2013.Among them,46 cases survived（survival group）and 77 cases died（death group）.All patients were recorded and analyzed for general information（gender,age）,oral dose of paraquat,concentration of blood paraquat on admission,worst APACHE Ⅱ score within 12 hours,hydrogen ion concentration index（pH）,bicarbonate ion（HCO3-）,White blood cell count（WBC）,serum potassium（K^＋）,creatinine（Cr）and other biochemical indicators.The differences of the indexes between the two groups were compared and the diagnostic value was analyzed.Results The median APACHE Ⅱscore（14points）,median WBC（22.06×10^9/L）and median Cr（176μmol/L）were significantly higher in death group than in survival group（3points,12.73×10^9/L,68μmol/L）,the differences were statistically significant（P〈0.05）.The median pH（7.30）,median HCO3-（14.5mmol/L）,and median K＋（2.91mmol/L）within 12 hours in death group were lower than those in the survival group（7.38,20.5mmol/L,3.41mmol/L）,the differences were statistically significant（P〈0.05）.The median survival time of death group was 6days（10hto 35d）.The worst APACHE Ⅱ score within 12 hours,WBC count and creatinine level were negatively correlated with survival time（r=-0.618,-0.824,-0.767,P〈0.05）.There was a positive correlation between pH and K＋and the survival time（r=0.714,0.796,P〈0.05）.The area under the ROC curve of the worst APACHE Ⅱ score within 12 hours was 0.992,the specificity was 0.961 and the sensitivity was 0.957.Conclusion The worst APACHEⅡ score within 12 hours,pH value,HCO3^-,WBC,K^＋and Cr levels in the patients with acute paraquat poisoning were related to the prognosis.12 hour worst APACHE Ⅱ score is a reliable index to judge the prognosis of patients with acute paraquat poisoning early.