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

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；PaO2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。

Comparison of evaluated value of three methods on the severity and prognosis of acute diquat poisoning

Objective To study the accuracy of three methods,namely severity index of paraquat poisoning (SIPP plasma), urine PQ concentration×poisoning time(SIPP urine), and APACHE II 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, SIPP urine and APACHE II score on the prognosis. Results The clinical data of heart rate, AST, creatinine, myoglobin and APACHE II score in survival group were lower than those in death group while the PaO2 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, SIPP urine and APACHE II 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 APACHE II 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 APACHE II score have good clinical value for assessing the severity and prognosis of ADP patients, and their accuracy increases sequentially.