肺泡动脉氧分压差与血乳酸水平动态监测对急性百草枯中毒患者的预后预测研究

Study on Prognosis Prediction of Pulmonary Alveolar-Arterial Oxygen Partial Pressure Difference and Blood Lactate Dynamic Monitoring in Patients with Acute Paraquat Poisoning

目的探讨肺泡动脉氧分压差(PA-aO2)与血乳酸水平动态监测对急性百草枯中毒患者的预后预测。方法选取2017年12月至2018年12月我院收治的60例急性百草枯中毒患者,根据出院1个月的随访结果将其分为存活组与死亡组。统计两组的死亡率、并发症发生率。对比两组的服毒时间、洗胃时间、PA-aO2、血乳酸水平,分析PA-aO2与血乳酸水平动态监测用于预测预后的灵敏度、特异度,同时以是否存活为二分类变量引入二元Logistic回归分析,为临床治疗提供依据。结果随访1个月,60例患者中死亡28例(46.67%),存活32例(53.33%)。存活组的并发症发生率为25.00%。与死亡组相比,存活组的服毒时间、洗胃时间较短,PA-aO2、血乳酸水平较低(P<0.05)。PA-aO2、血乳酸水平预测急性百草枯中毒患者预后的截断值分别为31.61 mm Hg、2.30 mmol/L,联合预测ROC曲线AUC为0.926(95%CI:0.829~0.978),灵敏度为96.43%,特异度为84.37%。结论PA-aO2与血乳酸水平与急性百草枯中毒患者预后关系十分密切,可为临床治疗工作提供指导。

Objective To explore the prognosis prediction of pulmonary alveolar-arterial oxygen partial pressure difference(PA-aO2 and blood lactate dynamic monitoring in patients with acute paraquat poisoning.Methods 60 patients with acute paraquat poisoning admitted to our hospital from December 2017 to December 2018 were selected and divided into survival group and death group according to follow-up results at 1 month after discharge.The mortality rate and the incidence of complications were counted.The poison-taking time,gastric lavage time,PA-aO2 and blood lactate level were compared between the two groups.The sensitivity and specificity of PA-aO2 and blood lactate dynamic monitoring for prognosis prediction were analyzed.Binary Logistic regression analysis was introduced by taking presence or absence of survival as binary variable to provide basis for clinical treatment.Results Following up for 1 month,among the 60 patients,28 cases(46.67%)were dead,and 32 cases(53.33%)were survival.The incidence of complications was 25.00%in the survival group.Compared with the death group,the poison-taking time and gastric lavage time of the survival group were shorter,and the PA-aO2 and blood lactate were lower(P<0.05).The cut-off values of PA-aO2 and blood lactate in prognosis prediction of patients with acute paraquat poisoning were 31.61 mm Hg and 2.30 mmol/L,respectively.The AUC of ROC curve of combined prediction was 0.926(95%CI:0.829 to0.978);The sensitivity and specificity were 96.43%and 84.37%,respectively.Conclusions PA-aO2 and blood lactate are very closely related to the prognosis of patients with acute paraquat poisoning,which can provide guidance for clinical treatment.