巴楚医学

目的:分析序贯器官衰竭评估(SOFA)评分和血清乳酸水平对急性有机磷中毒(AOPP)预后的预测价值。方法:回顾性收集黄山市人民医院急诊科82例AOPP患者的临床资料,根据患者预后分为存活组(n=68)和死亡组(n=14)。比较两组患者性别、年龄、血压、心率、呼吸、SOFA评分和实验室检查指标,并评估SOFA评分和血清乳酸水平对AOPP患者预后的预测价值。结果:死亡组患者的SOFA评分[(10.21±2.08)分vs (6.94±2.17)分]及血清乳酸水平[(4.28±4.72) mmol/L vs (2.28±1.04) mmol/L]均显著高于存活组(均P<0.05)。多因素Logistic回归分析显示,SOFA评分(OR=1.701,95%CI:1.253,2.310)和血清乳酸水平(OR=2.417,95%CI:1.116,5.234)均为AOPP患者院内死亡的独立危险因素。受试者工作特征曲线分析显示,SOFA评分的曲线下面积(AUC)为0.772,截断值为8.5分;血清乳酸水平的AUC为0.644,截断值为2.66 mmol/L;两者联合预测的AUC提升至0.846。结论:SOFA评分及血清乳酸水平为AOPP患者发生死亡的独立危险因素,两者联合应用可显著提高对预后的预测效能。建议在临床早期评估中综合使用这两项指标,以便更准确地识别高危患者。

Objective: To analyze the predictive value of the sequential organ failure assessment(SOFA) score and serum lactate level for the prognosis of patients with acute organophosphate poisoning(AOPP). Methods: Clinical data of 82 patients with AOPP admitted to the Department of Emergency in Huangshan City People's Hospital were retrospectively collected. According to clinical outcomes, patients were divided into a survival group(n=68) and a death group(n=14). Sex, age, blood pressure, heart rate, respiratory rate, SOFA score, and laboratory parameters were compared between the two groups. The predictive value of SOFA score and serum lactate levels for the prognosis of patients with AOPP was evaluated. Results: The SOFA score [(10.21±2.08) vs(6.94±2.17)] and serum lactate level [(4.28±4.72) mmol/L vs(2.28±1.04) mmol/L] of patients in the death group were significantly higher than those in the survival group(P<0.05). Multivariate Logistic regression analysis showed that the SOFA score(OR=1.701, 95%CI:1.253, 2.310) and serum lactate level(OR =2.417, 95%CI:1.116,5.234) were independent risk factors for inhospital mortality in AOPP patients. Receiver operating characteristic curve analysis demonstrated that the area under the curve(AUC) of the SOFA score was 0.772 with a cutoff of 8.5 points, the AUC of serum lactate level was 0.644 with a cutoff of 2.66 mmol/L, while the combined AUC of the two indicators was increased to 0.846. Conclusion: The SOFA score and serum lactate level are independent predictors of mortality in AOPP patients, and their combined use significantly improves prognostic accuracy. Therefore, both indicators should be jointly applied in early clinical assessment to identify high-risk patients more accurately.