摘要
目的探讨视神经鞘直径(ONSD)预测急性一氧化碳中毒迟发性脑病(DEACMP)的临床价值。方法采用回顾性研究方法。选择2017年1月至2020年2月沧州市中心医院收治的117例急性一氧化碳中毒患者作为研究对象。根据3个月内是否发生DEACMP将患者分为DEACMP组和非DEACMP组。收集患者的临床资料,包括性别、年龄、一氧化碳暴露时间、发现至住院时间、既往史、常规实验室指标和ONSD水平,比较是否发生DEACMP两组患者上述临床资料的差异。采用单因素和多因素Logistic回归分析筛选出影响患者发生DEACMP的危险因素,并绘制受试者工作特征曲线(ROC曲线)评估ONSD对发生DEACMP的预测能力。结果本研究DEACMP的发生率为10.3%(12/117)。与非DEACMP组比较,DEACMP组一氧化碳暴露时间延长〔h:9.5(8.1,10.6)比3.7(2.3,6.2),P<0.05〕,脑卒中史比例升高〔58.3%(7/12)比23.8%(25/105),P<0.05〕,血乳酸(Lac)水平明显升高〔mmoL/L:5.4(3.0,7.1)比2.6(1.9,3.9),P<0.05〕,ONSD增宽〔mm:4.8(4.6,4.9)比4.5(4.3,4.6),P<0.05〕。单因素Logistic回归分析显示,一氧化碳暴露时间、脑卒中史、丙氨酸转氨酶(ALT)、Lac和ONSD均是影响DEACMP发生的危险因素〔优势比(OR)和95%可信区间(95%CI)分别为1.662(1.277~2.164)、4.480(1.306~15.364)、1.039(1.003~1.076)、1.196(1.018~1.406)、1.555(1.173~2.062),P值分别为<0.001、0.017、0.034、0.030、0.002〕。多因素Logistic回归分析显示,一氧化碳暴露时间、脑卒中史及ONSD均是影响DEACMP发生的独立危险因素〔OR值和95%CI分别为1.523(1.135~2.043)、6.815(1.200~38.706)、1.707(1.135~2.566),P值分别为0.005、0.030和0.010〕。ROC曲线分析显示,ONSD预测DEACMP发生的ROC曲线下面积(AUC)=0.812,95%CI为0.713~0.911,P<0.001;当最佳截断值为4.7 mm时;其敏感度为75.0%,特异度为81.9%。结论ONSD有助于预测DEACMP的发生。
Objective To determine the predictive value of optic nerve sheath diameter(ONSD)for delayed encephalopathy after acute carbon monoxide poisoning(DEACMP).Methods A retrospective research was conducted.From January 2017 to February 2020,117 patients with acute carbon monoxide poisoning admitted into Cangzhou Central Hospital were enrolled,and the patients were divided into a DEACMP group and a non-DEACMP group according to whether DEACMP occurred within 3 months or not.The clinical data including sex,age,exposure duration of carbon monoxide,the time from discovery of the patient to hospital admission,past medical history,routine laboratory indicators,and ONSD level were collected and compared between the two groups.Univariate and multivariate Logistic regression analyses were used to assess risk factors of DEACMP,and the receiver operator characteristic curve(ROC curve)was constructed to evaluate the predictive value of ONSD for the occurrence of DEACMP.Results The incidence of DEACMP was 10.3%(12/117)in this study.Compared with non-DEACMP group,the patients in DEACMP group had longer exposure duration of carbon monoxide[hours:9.5(8.1,10.6)vs.3.7(2.3,6.2),P<0.05],higher proportion of history of stroke[58.3%(7/12)vs.23.8%(25/105),P<0.05],higher blood lactic acid[Lac(mmoL/L):5.4(3.0,7.1)vs.2.6(1.9,3.9),P<0.05],and broader ONSD[mm:4.8(4.6,4.9)vs.4.5(4.3,4.6),P<0.05].Univariate Logistic regression analysis showed that exposure duration of carbon monoxide,history of stroke,alanine aminotransferase(ALT),Lac,and ONSD were the independent risk factors of the occurrence of DEACMP[odds ratio(OR)and 95%confidence interval(95%CI)were 1.662(1.277-2.164),4.480(1.306-15.364),1.039(1.003-1.076),1.196(1.018-1.406),1.555(1.173-2.062),P values were<0.001,0.017,0.034,0.030,0.002,respectively].Multivariate Logistic regression analysis showed that exposure duration of carbon monoxide,history of stroke,and ONSD were independent risk factors of occurrence of DEACMP[OR and 95%CI were 1.523(1.135-2.043),6.815(1.200-38.706),1.707(1.135-2.566),P values were 0.005,0.030,0.010,respectively].ROC curve analysis showed that the area under ROC curve(AUC)of ONSD for predicting DEACMP was 0.812,95%CI was 0.713-0.911,P<0.001;the corresponding sensitivity was 75.0%and specificity was 81.9%when the cut-off value of ONSD was 4.7 mm.Conclusion ONSD contributes to predict DEACMP.
作者
冯顺易
张萌
吕广卫
王淑丽
杜雨森
张素丽
张媛媛
Feng Shunyi;Zhang Meng;Lyu Guangwei;Wang Shuli;Du Yusen;Zhang Suli;Zhang Yuanyuan(Department of Emergency,Cangzhou Central Hospital,Cangzhou 061000,Hebei,China;Nursing Department,Cangzhou Infectious Diseases Hospital,Cangzhou 061000,Hebei,China)
出处
《中国中西医结合急救杂志》
CAS
CSCD
北大核心
2022年第2期159-162,共4页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
河北省沧州市科技计划项目(204106125)。
关键词
视神经鞘直径
一氧化碳中毒
迟发性脑病
预测价值
Optic nerve sheath diameter
Carbon monoxide poisoning
Delayed encephalopathy
Predictive value
