探索急性有机磷农药中毒早期可以预测需要机械通气的指标

Predictor indexes for requirement of mechanical ventilation in patients of early-stage acute organophosphate poisoning

摘要:

目的  探索急性有机磷农药中毒（AOPP）早期可以预测需要机械通气的指标。方法  回顾该院2012年7月-2014年12月收治AOPP患者58例，根据患者24 h内是否行机械通气治疗，将患者分为机械通气组和非机械通气组。统计患者入院的平均动脉压（Map）、动脉血初始乳酸（Lac）及入院6 h Lac、中心静脉血氧饱和度（ScvO2）、标准碱剩余（SBE）、全血乙酰胆碱酯酶（AchE）、动脉血氧饱和度（SaO2）、动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）、吸入氧浓度（FiO2），计算氧合指数（PaO2/FiO2）、6 h乳酸清除率（6 h-LCR)、中毒严重程度评分（PSS）及急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分。比较两组各指标的差异，并分析其与机械通气的相关性，观察各相关指标预测需要机械通气的能力，并比较其优越性。结果  机械通气组的APACHEⅡ评分、PSS、P（A-a）O2高于非机械通气组，差异有统计学意义（P <0.05）。机械通气组SBE、AchE、SaO2、PaO2、PaO2/FiO2低于非机械通气组，差异有统计学意义（P <0.05）。两组年龄、性别、Map、Lac、6 h-LCR、ScvO2、PaCO2差异无统计学意义（P >0.05）。机械通气与APACHEⅡ评分、PSS评分、SBE、AChE、SaO2、PaO2、PaO2/FiO2、P（A-a）O2显著相关性（r =0.661，0.647，-0.396，-0.371，-0.367，-0.504，-0.684，0.439，P <0.05）。对需要机械通气的预测能力：APACHEⅡ、PSS、P（A-a）O2、SBE、AChE、SaO2、PaO2、PaO2/FiO2的AUC分别为0.883、0.885、0.772、0.742、0.731、0.759、0.801和0.927。敏感性分别为92.60%、55.60%、77.80%、77.40%、71.00%、74.20%、77.40%和87.10%。特异性分别为71.00%、90.30%、74.20%、49.10%、66.70%、77.80%、70.40%和85.20%。■值分别为26.25、15.00、23.18、0.43、0.18、0.85、0.08和0.35。结论  AOPP早期可以预测需要机械通气的指标有APACHEⅡ、PSS、P（A-a）O2、SBE、AchE、SaO2、PaO2、PaO2/FiO2，其中以PaO2/FiO2最优越。

Abstract:

Objective To study the predictor indexes for requirement of mechanical ventilation in patients of acute organophosphate poisoning (AOPP) in early stage, in order to improve the success rate of rescue. Methods Fifty-eight patients with AOPP from July 2012 to December 2014 were retrospectively studied. According to the line whether mechanical ventilation treatment was needed in 24 hours or not, the patients were divided into two groups: the mechanical ventilation group and non-mechanical ventilation group. The average arterial pressure (Map) and arterial blood lactic acid (Lac) on admission, and Lac, central venous oxygen saturation (ScvO2), standard base excess (SBE), remaining acetylcholinesterase (AChE), arterial oxygen saturation (SaO2), arterial blood oxygen partial pressure (PaO2), arterial blood CO2 partial pressure (PaCO2), inspired oxygen fraction (FiO2) 6 hours after admission were detected. PaO2/FiO2 and 6-hour lactate clearance rate, poisoning severity score (PSS) and acute physiology and chronic health evaluation system Ⅱ (APACHE Ⅱ) score were calculated. The differences in the various indicators were compared between the two groups, and their correlations with mechanical ventilation were analyzed. The prediction ability of mechanical ventilation of relevant indexes was observed and their advantages were compared. Results The APACHE II score and PSS score of the mechanical ventilation group were higher than those of the non-mechanical ventilation group with significant differences (P < 0.05). SBE, AchE, SaO2, PaO2 and PaO2/FiO2 of the mechanical ventilation group were significantly lower than those of the non-mechanical ventilation group (P < 0.05). The age, sex, Map, Lac, 6 h-LCR, ScvO2 and PaCO2 of both groups were of no significant differences (P > 0.05). Mechanical ventilation was obviously correlated to the APACHE Ⅱ score, PSS score, SBE, AchE, SaO2, PaO2, PaO2/FiO2 and P (A-a) O2 (r = 0.661, 0.647, -0.396, -0.371, -0.367, -0.504, -0.684, 0.439; P < 0.05). Concerning the ability to predict the need for mechanical ventilation, the AUC of APACHE Ⅱ, PSS, P (A-a) O2, SBE, AChE, SaO2, PaO2 and PaO2/FiO2 AUC was 0.883, 0.885, 0.772, 0.742, 0.731, 0.759, 0.801 and 0.927 respectively. Their sensitivity was 92.60%, 55.60%, 77.80%, 77.40%, 71.00%, 74.20%, 77.40% and 87.10% respectively. Their specificity was 71.00%, 90.30%, 74.20%, 49.10%, 66.70%, 77.80%, 70.40% and 85.20% respectively. The ■ values were 26.25, 15.00, 23.18, 0.43, 0.18, 0.85, 0.08 and 0.35 respectively. Conclusions The indexes of predicting the need for mechanical ventilation in early stage of AOPP are APACHE Ⅱ, PSS, P (A-a) O2, SBE, AChE, SaO2, PaO2 and PaO2/FiO2, among which PaO2/FiO2 is the most advantageous one.