QTc间期值预测急性有机磷农药中毒患者预后的价值

Value of QTc interval in the prediction of the prognosis of patients with acute organophosphorus pesticide poisoning

目的分析急性有机磷农药中毒患者早期的心电图特点,探索QTc间期值对患者预后的预测价值。方法回顾性分析自2015年1月至2017年1月淮安市第一人民医院急诊科收治的急性有机磷农药中毒患者,依据患者中毒后30 d的转归情况分为存活组与死亡组,进行对照性研究,绘制ROC曲线分析早期心电图QTc间期值对患者预后的价值。结果共计84例患者纳入本研究,其中男38例,女46例;随访30 d,共计死亡29例,存活55例,病死率为34.5%,2组之间中毒剂量差异有统计学意义(P<0.05)。入院初始,存活组QTc间期均值为398.9 ms,死亡组为452.7 ms,2组差异有统计学意义(P<0.05);依据QTc间期值绘制的ROC曲线下面积为0.942,截断值为405.2 ms,灵敏度为87.3%,特异度为92.4%,Youden指数为0.797,Kappa系数为0.835;入院24 h后,存活组QTc间期值均值为415.7 ms,死亡组为468.3 ms,2组间差异有统计学意义(P<0.05),ROC曲线下面积为0.768,截断值432.4 ms,灵敏度为78.2%,特异度为51.9%,Youden指数为0.301,Kappa系数为0.324。结论早期的QTc间期值对急性有机磷农药中毒患者的预后有较好的预测价值。

Objective To analyze the features of initial ECG in patients with acute organophosphorus pesticide poisoning, and also to explore the value of QTc interval in predicting the prognosis of patients with acute organophosphorus pesticide poisoning.Methods A retrospective analysis was made in the patients who were hospitalized for treatment of acute organophosphorus pesticide poisoning from January 2015 to January 2017 in the Emergency Department and Intensive Care Unit(ICU) of the hospital. Eighty-four patients were included in the study, of whom 38 were male and 46 were female. In accordance with the prognosis of the patients 30 days after intoxication, the patients were divided into the survival group and the death group. Then, a comparative study was made in the research, and ROC curves were plotted to evaluate the value of QTc interval of initial ECG in the prediction of the prognosis of the patients.Results Thirty-day followed-up indicated that 29 patients died and 55 patients survived, with a mortality rate of 34.52%. Statistical significance could be seen in intoxication dosage, when comparisons were made between the 2 groups(P<0.05). At initial period of hospitalization, the average value of QTc interval of the survival group was 398.9 ms, while that of the death group was 432.4 ms. Statistical significance could be found when comparisons were made between them(P<0.05). The ROC area under the curve plotted by using the QTc interval was 0.942, with the cross-sectional value of 405.2 ms, sensitivity of 87.3%, specificity of 92.4%, Youden index of 0.797 and Kappa coefficient of 0.835. Twenty four hours after hospitalization, the average value of QTc interval of the survival group was 415.7 ms, while that of the death group was 468.3 ms. Statistical significance could also be noted when comparisons were made between them(P<0.05). The ROC area under the curve was 0.768, with the cross-sectional value of 432.4 ms, sensitivity of 78.2%, specificity of 51.9%, Youden index of 0.301 and Kappa coefficient of 0.324.Conclusion The initial QTc interval value was of good value for the prediction of the prognosis of patients with acute organophosphorus pesticide poisoning.