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目的:研究百草枯中毒患者乳酸、12h乳酸清除率和APACHEⅡ评分与患者预后的相关性。方法:回顾性研究2009-01-2013-12百草枯中毒患者95例,按生存组和死亡组比较入院时乳酸值、12h乳酸清除率和APACHEⅡ评分与患者预后的分析。结果:急性百草枯中毒死亡组患者入院时乳酸、APACHEⅡ评分、24h APACHEⅡ评分均高于生存组(P<0.05),乳酸清除率低于生存组(P<0.05)。乳酸、入院APACHEⅡ评分、24hAPACHEⅡ评分与死亡呈正相关。12h乳酸清除率与死亡呈显著负相关。入院时APACHEⅡ评分和乳酸清除率的ROC曲线下面积大于入院时乳酸和入院后24hAPACHEⅡ评分的ROC曲线下面积,研究对象与预测中毒预后的良好指标百草枯血浆浓度面积接近。根据最佳截断值,乳酸、乳酸清除率、百草枯血浆浓度、入院APACHEⅡ评分、24hAPACHEⅡ评分预测病死率的灵敏度、特异度、Youden指数分别为0.727~0.909,0.667~0.921,0.485~0.642。结论:入院时APACHEⅡ评分和早期乳酸清除率对急性百草枯中毒病死有更好的预测能力。
OBJECTIVE: To study the correlation between lactic acid, 12 h lactic acid clearance and APACHE II score in patients with paraquat poisoning and the prognosis of patients. Methods: A retrospective study of 95 paraquat poisoning patients from January 2009 to December 2013 was performed. The lactic acid value, lactic acid clearance rate and APACHEⅡ score at admission were compared between the survival group and the death group. The prognosis was analyzed. Results: Lactic acid, APACHEⅡscore and APACHEⅡscore at admission were significantly higher in patients with acute paraquat poisoning than those in survivors (P <0.05). The clearance rate of lactate was lower than that in survivors (P <0.05). Lactic acid, admission APACHE Ⅱ score, 24hAPACHE Ⅱ score and death were positively correlated. 12h lactic acid clearance and death were significantly negatively correlated. The area under the ROC curve of APACHE II score and lactic acid clearance rate at admission was larger than the area under the ROC curve of lactate at admission and 24hAPACHE II score after admission. The study area was close to that of paraquat, a good indicator of prognosis of poisoning. According to the best cutoff value, the sensitivity, specificity and Youden index of lactic acid, lactic acid clearance, paraquat plasma concentration, admission APACHEⅡscore and 24hAPACHEⅡscore predictive mortality were0.727 ~ 0.909,0.667 ~ 0.921,0.485 ~ 0.642 respectively. CONCLUSIONS: APACHE II scores and early lactic acid clearance rates at admission are better predictors of acute paraquat poisoning.