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目的通过回顾性地总结临床病例资料,探讨急性口服百草枯(paraquat,PQ)中毒患者早期血清肌酐值变化与出现呼吸衰竭的关系,以期在中毒早期通过血清肌酐水平的变化预测患者病程中出现呼吸衰竭的可能性,指导临床诊断及治疗。方法选取军事医学科学院附属医院中毒救治科2008~2012年PQ中毒患者72例,按照病程中是否发生呼吸衰竭将其分为两组,A组为出现呼吸衰竭的患者,共28例;B组为未出现呼吸衰竭的患者,共44例。取中毒后来院就诊首次测得血清肌酐基值及中毒48 h内血清肌酐最高值,计算二者差值及比率进行比较。在此基础上,分别计算灵敏度、特异度、准确度、Youden指数、ROC曲线下面积,绘制ROC曲线。根据准确度和Youden指数确定各指标的最佳预测界值及预测效果。结果两组患者在肌酐基值、高值、比率、差值的差异存在统计学意义。肌酐基值的最佳预测界值为53μmol/L,预测效果中等。其余3项预测效果均较佳,其中肌酐高值的最佳预测界值为183μmol/L,肌酐比率的最佳预测界值为3.39,肌酐差值的最佳预测界值为113μmol/L。结论在PQ中毒早期48 h内,血清肌酐水平上升速率越快,出现呼吸衰竭的可能性越大。通过计算中毒后血清肌酐基值、48 h内高值、差值及比率,与研究得出的各个预测界值进行比较,如达到预测界值,则说明发生呼吸衰竭的可能性极大。
OBJECTIVE: To retrospectively summarize the clinical data of patients with acute paraquat (PQ) poisoning in patients with early serum creatinine changes and the occurrence of respiratory failure, in order to early poisoning through the serum creatinine level changes in the prediction of the patient’s course of breathing The possibility of failure, to guide clinical diagnosis and treatment. Methods 72 cases of PQ poisoning in the Affiliated Hospital of Military Academy of Medical Sciences from 2008 to 2012 were divided into two groups according to whether there was respiratory failure in the course of the disease. Group A were patients with respiratory failure, a total of 28 cases In patients without respiratory failure, a total of 44 cases. After poisoning, the serum creatinine value and the highest serum creatinine within 48 h were measured for the first time in hospital, and the difference and the ratio between the two were calculated. On this basis, the sensitivity, specificity, accuracy, Youden index, area under the ROC curve were calculated and the ROC curve was drawn. According to the accuracy and the Youden index, the best predictive value and forecasting effect of each index are determined. Results The differences of creatinine basis value, high value, ratio and difference between the two groups were statistically significant. The best predictive value of creatinine was 53μmol / L, and the predicted effect was moderate. The best predictive value of creatinine was 183μmol / L, the best predictive value of creatinine ratio was 3.39, and the best predictive value of creatinine difference was 113μmol / L. Conclusion Within 48 hours after the onset of PQ poisoning, the rate of increase of serum creatinine is higher and the possibility of respiratory failure is higher. By calculating the base value of serum creatinine after poisoning, high value within 48 h, the difference and the ratio, with the study of the predicted cutoff value for comparison, such as to reach the cutoff value, then the possibility of respiratory failure is extremely likely.