3种方法对急性敌草快中毒严重程度和预后评估价值的比较
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摘要
目的研究入院时百草枯中毒严重指数(SIPP血浆)、尿液PQ浓度×中毒时间(SIPP_(尿液))、APACHEⅡ评分3种方法用于评估急性敌草快中毒(ADP)的严重程度和患者预后的准确性。方法采用回顾性研究,将2015年5月-2018年11月某院急诊收治的急性敌草快中毒病例按结局分组,比较组间差异并采用logistic回归分析其预后的独立危险因素,最后采用ROC曲线分析3种方法用于预后评估的准确性。结果存活组患者心率、谷草转氨酶、肌酐、肌红蛋白、APACHEⅡ评分等低于死亡组;PaO_2高于死亡组,差异有统计学意义(P<0.05);logistic回归分析结果显示,服药中毒至入院时间、心肌酶谱、SIPP_(血浆)、肌红蛋白、SIPP_(尿液)及APACHEⅡ评分等为预后的危险因素(P<0.05);ROC曲线分析结果显示,SIPP_(血浆)、SIPP_(尿液)及APACHEⅡ评分用于预后评估的最佳界值分别为3 619(h·mg/L)、164(h·mg/L)和6(h·mg/L),且AUC及Youden指数依次增大,差异有统计学意义(P<0.05)。结论 SIPP_(血浆)、SIPP_(尿液)、APACHEⅡ评分3种方法用于评估急性敌草快中毒的严重程度和患者的预后情况均具有良好的临床价值,且其准确性依次增加。
Objective To study the accuracy of three methods,namely severity index of paraquat poisoning(SIPP_(plasma)), urine PQ concentration ×poisoning time(SIPPurine), and APACHEⅡ in the evaluation of severity and prognosis of acute diquat poisoning(ADP). Methods A retrospective study was carried out to divide patients with ADP of our hospital from May 2015 to November 2018 into survival group and death group. The differences of indexes were compared between the two groups,and Logistic regression analysis was used to analyze the independent risk factors for prognosis in ADP patients. The ROC curve was used to analyze the accuracy of SIPP_(plasma), SIPPurineand APACHEⅡ score on the prognosis. Results The clinical data of heart rate, AST, creatinine, myoglobin and APACHEⅡ score in survival group were lower than those in death group while the PaO_2 were higher than those in death group(P<0.05). Logistic regression analysis showed that time from poisoning to hospitalization, myocardial enzymogram, SIPP_(plasma), myoglobin, SIPPurineand APACHEⅡ score were independent risk factors for prognosis of ADP patients(P<0.05). The ROC curve analysis showed that the optimal cut-off values of SIPP_(plasma), SIPP_(urine) and APACHEⅡ score for prognosis evaluation of ADP were 3 619(h·mg/L), 164(h·mg/L) and 6(h·mg/L)respectively, and the AUC and Youden index were increased in turn( P <0.05). Conclusion SIPP_(plasma), SIPP_(urine) and APACHEⅡ score have good clinical value for assessing the severity and prognosis of ADP patients, and their accuracy increases sequentially.
Objective To study the accuracy of three methods,namely severity index of paraquat poisoning(SIPP_(plasma)), urine PQ concentration ×poisoning time(SIPPurine), and APACHEⅡ in the evaluation of severity and prognosis of acute diquat poisoning(ADP). Methods A retrospective study was carried out to divide patients with ADP of our hospital from May 2015 to November 2018 into survival group and death group. The differences of indexes were compared between the two groups,and Logistic regression analysis was used to analyze the independent risk factors for prognosis in ADP patients. The ROC curve was used to analyze the accuracy of SIPP_(plasma), SIPPurineand APACHEⅡ score on the prognosis. Results The clinical data of heart rate, AST, creatinine, myoglobin and APACHEⅡ score in survival group were lower than those in death group while the PaO_2 were higher than those in death group(P<0.05). Logistic regression analysis showed that time from poisoning to hospitalization, myocardial enzymogram, SIPP_(plasma), myoglobin, SIPPurineand APACHEⅡ score were independent risk factors for prognosis of ADP patients(P<0.05). The ROC curve analysis showed that the optimal cut-off values of SIPP_(plasma), SIPP_(urine) and APACHEⅡ score for prognosis evaluation of ADP were 3 619(h·mg/L), 164(h·mg/L) and 6(h·mg/L)respectively, and the AUC and Youden index were increased in turn( P <0.05). Conclusion SIPP_(plasma), SIPP_(urine) and APACHEⅡ score have good clinical value for assessing the severity and prognosis of ADP patients, and their accuracy increases sequentially.
引文
[1]任引津,张寿林.实用急性中毒全书[M].北京:人民卫生出版社,2003.
[2]刘露,吴霜,蔡舒,等.急性敌草快中毒的胸部CT表现[J].现代预防医学,2018,45(16):3048-3051,3068.
[3]Jovic'-Stosic'J,Babic'G,Todorovic'V.Fatal diquat intoxication[J].Vojnosanitetski Pregled,2009,66(6):477-481.
[4]杨理健.当前要重视百草枯水剂换成敌草快销售使用[J].山东农药信息,2016,(5):25.
[5]李杨,胡珍丽,邱平.尿液百草枯快速定性试验在急性百草枯中毒预后评估中应用价值[J].临床军医杂志,2018,46(8):908-910.
[6]牛丽丹,张建新,郝同琴,等.入院时血浆百草枯浓度及百草枯中毒严重指数评估患者中毒程度及预后的价值比较[J].实用医院临床杂志,2018,15(3):87-89.
[7]Djurdjevic D,Mirjana D,Milica N,et al.Glutathione cycle in diquat neurotoxicity:assessed by intrastriatal pre-treatment with glutathione reductase[J].Acta Veterinaria-Beograd,2013,63(2/3):159-175.
[8]Saeed SA,Wilks MF,Coupe M.Acute diquat poisoning with intracerebral bleeding[J].Postgraduate Medical Journal,2001,77(97):329-332.
[9]Magalhaes N,Carvalho F,Dinis-Oliveira RJ.Human and experimental toxicology of diquat poisoning:Toxicokinetics,mechanisms of toxicity,clinical features,and treatment[J].Human and Experimental Toxicology,2018,37(11):1131-1160.
[10]Kim Hj KH.Toxicokineties of paraquat in Korean patients with acute poisoning[J].Korean J Physiol Pharmaeol,2016,20(1):35-39.
[11]彭怡,李浩然,张志清.生物样本中季铵类除草剂检测的研究进展[J].中国医院药学杂志,2018,38(9):1010-1013.
[2]刘露,吴霜,蔡舒,等.急性敌草快中毒的胸部CT表现[J].现代预防医学,2018,45(16):3048-3051,3068.
[3]Jovic'-Stosic'J,Babic'G,Todorovic'V.Fatal diquat intoxication[J].Vojnosanitetski Pregled,2009,66(6):477-481.
[4]杨理健.当前要重视百草枯水剂换成敌草快销售使用[J].山东农药信息,2016,(5):25.
[5]李杨,胡珍丽,邱平.尿液百草枯快速定性试验在急性百草枯中毒预后评估中应用价值[J].临床军医杂志,2018,46(8):908-910.
[6]牛丽丹,张建新,郝同琴,等.入院时血浆百草枯浓度及百草枯中毒严重指数评估患者中毒程度及预后的价值比较[J].实用医院临床杂志,2018,15(3):87-89.
[7]Djurdjevic D,Mirjana D,Milica N,et al.Glutathione cycle in diquat neurotoxicity:assessed by intrastriatal pre-treatment with glutathione reductase[J].Acta Veterinaria-Beograd,2013,63(2/3):159-175.
[8]Saeed SA,Wilks MF,Coupe M.Acute diquat poisoning with intracerebral bleeding[J].Postgraduate Medical Journal,2001,77(97):329-332.
[9]Magalhaes N,Carvalho F,Dinis-Oliveira RJ.Human and experimental toxicology of diquat poisoning:Toxicokinetics,mechanisms of toxicity,clinical features,and treatment[J].Human and Experimental Toxicology,2018,37(11):1131-1160.
[10]Kim Hj KH.Toxicokineties of paraquat in Korean patients with acute poisoning[J].Korean J Physiol Pharmaeol,2016,20(1):35-39.
[11]彭怡,李浩然,张志清.生物样本中季铵类除草剂检测的研究进展[J].中国医院药学杂志,2018,38(9):1010-1013.