血乳酸与碳氧血红蛋白对一氧化碳中毒患者远期预后的预测价值

Predictive value of plasma lactate and carboxyhemoglobin on long-term prognosis in patients with carbon monoxide poisoning

目的探讨血乳酸与碳氧血红蛋白对一氧化碳中毒(COP)患者远期预后的预测价值。方法收集2017年1月~2019年1月桂林医学院第二附属医院急诊科收治的108例COP患者的临床资料,根据是否遗留神经系统并发症将其分为预后不良组(n=16)和预后良好组(n=92)。运用受试者工作特征(ROC)曲线分析血乳酸和碳氧血红蛋白对COP患者远期预后的预测价值。结果预后不良组患者的血乳酸、碳氧血红蛋白水平均高于预后良好组,差异有统计学意义(P<0.05)。血乳酸、碳氧血红蛋白ROC曲线下面积分别为0.816(95%CI:0.682~0.949)、0.672(95%CI:0.529~0.814)。当血乳酸取最佳临界值7.95 mmol/L时,敏感度为68.8%,特异性为94.6%;当碳氧血红蛋白取最佳临界值20.2%时,敏感度为93.8%,特异性为33.7%。序列试验约登(Youden)指数大于平行试验,其敏感度和特异性分别为64.5%、96.4%,98.1%、31.9%。结论碳氧血红蛋白与血乳酸对COP患者远期预后的预测均有一定的价值,联合血乳酸值与碳氧血红蛋白浓度对综合评估COP患者预后情况特异性更高,可能更具有临床价值。

Objective To explore the predictive value of plasma lactate and carboxyhemoglobin on long-term prognosis in patients with carbon monoxide poisoning(COP).Methods The clinical data of 108 COP patients admitted to the Emergency Department of the Second Affiliated Hospital of Guilin Medical University from January 2017 to January 2019 were collected,and they were divided into poor prognosis group(n=16)and good prognosis group(n=92)according to whether there were remaining neurological complications.The receiver operating characteristic(ROC)curve was used to analyze the predictive value of plasma lactate and carboxyhemoglobin for the long-term prognosis of patients with COP.Results The levels of plasma lactate and carboxyhemoglobin in the poor prognosis group were higher than those in the good prognosis group,and the differences were statistically significant(P<0.05).The areas under the ROC curve of plasma lactate and carboxyhemoglobin were 0.816(95%CI:0.682-0.949)and 0.672(95%CI:0.529-0.814),respectively.When the optimal threshold value of plasma lactate was 7.95 mmol/L,the sensitivity was 68.8%and the specificity was 94.6%.When the optimal threshold value of carboxyhemoglobin was 20.2%,the sensitivity was 93.8%and the specificity was 33.7%.The Youden index of the serial test was greater than that of the parallel test,and their sensitivity and specificity were 64.5%,96.4%,and 98.1%,31.9%,respectively.Conclusion Both carboxyhemoglobin and plasma lactate have certain value in predicting the long-term prognosis of patients with COP.The combination of plasma lactate value and carboxyhemoglobin concentration has a higher specificity for the prognosis of COP patients,which may be of more clinical value.