本文選題：百草枯中毒 + 超急性期��； 參考：《安徽醫(yī)科大學(xué)》2017年碩士論文

【摘要】：研究一百草枯中毒24小時(shí)內(nèi)肺部磨玻璃影體積的預(yù)后價(jià)值目的探討百草枯中毒(PQ)24小時(shí)內(nèi)肺CT磨玻璃影(GGO)體積與患者預(yù)后的關(guān)系。材料與方法回顧性分析58例百草枯中毒患者的一般資料、中毒24小時(shí)內(nèi)的臨床表現(xiàn)、實(shí)驗(yàn)室檢查結(jié)果及CT影像學(xué)表現(xiàn),根據(jù)百草枯中毒90天內(nèi)患者的生存情況分為生存組和死亡組,比較兩組患者的上述指標(biāo),對(duì)其具有顯著統(tǒng)計(jì)學(xué)差異的客觀指標(biāo)采用Logistic回歸分析,尋找有獨(dú)立預(yù)后效應(yīng)的因子,然后進(jìn)一步采用ROC曲線分析其預(yù)測(cè)死亡的效能;同時(shí),根據(jù)58例患者有無(wú)GGO進(jìn)一步分為GGO組和無(wú)GGO組,采用Kaplan-Meier生存曲線分析GGO組和無(wú)GGO組的存活率。結(jié)果(1)生存組33例,其中男性15例,女性18例,平均年齡為(34.91±10.67)歲,死亡組25例,其中男性8例,女性17例,平均年齡為(38.72±13.97)歲,估計(jì)中毒劑量、胸悶有無(wú)、Pa O2、Pa CO2、白細(xì)胞、谷草轉(zhuǎn)氨酶、肌酐等7個(gè)指標(biāo)存在統(tǒng)計(jì)學(xué)差異(P0.05),即生存組明顯高于死亡組,年齡、性別、食管燒灼感、咽痛、氧飽和度、PH、中性粒細(xì)胞、谷丙轉(zhuǎn)氨酶、總膽紅素等9個(gè)指標(biāo)無(wú)統(tǒng)計(jì)學(xué)差異(P0.05),即生存組與死亡組之間無(wú)明顯差異;(2)CT表現(xiàn)對(duì)比示:百草枯中毒24小時(shí)內(nèi)GGO例數(shù)、GGO體積、GGO體積比及GGO累及肺段數(shù)4個(gè)指標(biāo)存在統(tǒng)計(jì)學(xué)差異(P0.05),無(wú)明顯異常、肺紋理增多、實(shí)變、胸腔積液、掃描時(shí)間等5個(gè)指標(biāo)無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。(3)Logistic回歸分析提示,百草枯中毒24小時(shí)內(nèi)GGO體積、血肌酐、Pa O2是判斷百草枯中毒預(yù)后的獨(dú)立預(yù)后因子(P0.05),Pa CO2、谷草轉(zhuǎn)氨酶、白細(xì)胞計(jì)數(shù)不是判斷百草枯中毒預(yù)后的獨(dú)立預(yù)后因子(P0.05);(4)ROC曲線示:GGO體積(AUC=0.837)曲線下面積大于血肌酐(AUC=0.832)、Pa O2(AUC=0.739),百草枯中毒24小時(shí)內(nèi)肺部CT的GGO體積(cut-off值為7.62cc3)預(yù)測(cè)患者死亡的敏感性、特異性和準(zhǔn)確性分別為96.97%、68%、74%。(5)GGO組存活率為32.1%,無(wú)GGO組則高達(dá)80%(P0.05)。結(jié)論百草枯中毒24小時(shí)內(nèi)GGO體積、血肌酐、Pa O2均可預(yù)測(cè)百草枯中毒的預(yù)后結(jié)局,但GGO體積具有更好的預(yù)測(cè)效能及敏感性、準(zhǔn)確性,即百草枯中毒24小時(shí)內(nèi)GGO有無(wú)、體積大小對(duì)于判斷百草枯中毒預(yù)后具有客觀的臨床指導(dǎo)價(jià)值。研究二百草枯中毒肺部磨玻璃影體積早期動(dòng)態(tài)變化的預(yù)后價(jià)值目的探討百草枯中毒早期(7天內(nèi))肺部CT磨玻璃影體積的動(dòng)態(tài)變化與預(yù)后的關(guān)系。材料與方法回顧性分析42例百草枯中毒后24小時(shí)內(nèi)、2天、4天及7天完整CT資料的中毒患者的影像學(xué)變化,根據(jù)百草枯中毒90天內(nèi)患者的生存情況分為生存組和死亡組,比較兩組患者GGO體積動(dòng)態(tài)變化的特點(diǎn),采用重復(fù)測(cè)量方差分析對(duì)其進(jìn)行分析、比較,通過ROC曲線分析四個(gè)時(shí)間點(diǎn)預(yù)測(cè)死亡的效能。結(jié)果生存組30例,死亡組12例,(1)隨著時(shí)間推移,兩組患者肺部CT出現(xiàn)異常征象的人數(shù)均未見明顯變化;(2)重復(fù)測(cè)量方差分析的結(jié)果示:時(shí)間因素有效應(yīng)(F=13.458,P=0.001),即GGO體積隨時(shí)間變化而變化,且時(shí)間因素與分組因素有交互作用(F=13.436,P=0.001),即各時(shí)間點(diǎn)測(cè)得的GGO體積隨分組改變而改變;組間因素的計(jì)算結(jié)果表明,分組因素有效應(yīng)(F=14.024,P=0.001),即生存組與死亡組之間GGO體積總體而言有統(tǒng)計(jì)學(xué)差異;(3)組間比較中,GGO體積在百草枯中毒2天、4天、7天三個(gè)時(shí)間點(diǎn)上生存組與死亡組之間有統(tǒng)計(jì)學(xué)差異(P0.05),在百草枯中毒24小時(shí)這一時(shí)間點(diǎn)上生存組與死亡組之間無(wú)統(tǒng)計(jì)學(xué)差異(P0.05),即在上述三個(gè)時(shí)間點(diǎn)生存組GGO體積明顯低于死亡組,在百草枯中毒24小時(shí)這一時(shí)間點(diǎn)上生存組GGO體積與死亡組差別不大;組內(nèi)比較中,生存組內(nèi)四個(gè)時(shí)間點(diǎn)之間沒有統(tǒng)計(jì)學(xué)差異,而死亡組之間各時(shí)間點(diǎn)之間是有統(tǒng)計(jì)學(xué)差異的,即死亡組之間隨著時(shí)間推移,CT隨訪顯示GGO體積呈現(xiàn)進(jìn)行性增大的趨勢(shì);(4)百草枯中毒24小時(shí)、2天、4天、7天的GGO體積曲線下面積分別為0.524、0.741、0.798、0.833,呈現(xiàn)增加趨勢(shì),預(yù)測(cè)死亡的敏感性(33.33%、83.33%、91.67%、91.67%)增加,而特異性(92.86%、64.29%、71.43%、71.43%)降低;結(jié)論百草枯中毒早期GGO體積呈現(xiàn)平穩(wěn)變化提示患者預(yù)后良好,呈現(xiàn)快速增加、進(jìn)展則預(yù)示患者結(jié)局不良,百草枯中毒早期GGO體積的動(dòng)態(tài)變化對(duì)于預(yù)測(cè)百草枯中毒預(yù)后具有準(zhǔn)確、客觀的判斷,對(duì)于臨床治療及評(píng)估具有良好的指導(dǎo)價(jià)值。
[Abstract]:To study the prognostic value of the volume of lung glass shadow within 24 hours of the one hundred paraquat intoxication objective to explore the relationship between the volume of CT ground glass shadow (GGO) and the prognosis of the patients within 24 hours of paraquat poisoning (PQ). Materials and methods reviewed the general data of 58 cases of paraquat poisoning, the clinical manifestations, laboratory results and C in the 24 hours. T imaging findings were divided into survival and death groups according to the survival of paraquat intoxication within 90 days. Compared with the above indicators in the two groups, the objective indicators with significant statistical differences were analyzed by Logistic regression analysis to find the factors that had independent prognostic effects, and then a ROC curve was used to analyze the effect of their prediction of death. At the same time, 58 patients were divided into GGO group and non GGO group without GGO, and the survival rate of GGO and non GGO groups was analyzed by Kaplan-Meier survival curve. Results (1) the survival group was 33 cases, including 15 male and 18 female, with the average age of (34.91 + 10.67) years and 25 in the death group, including 8 men and 17 women, average age of (38.72 + 13.97). 7 indexes of Pa O2, Pa CO2, leukocyte, gluten transaminase and creatinine were statistically different (P0.05), that is, the survival group was significantly higher than the death group, that is, age, sex, esophagus burning sensation, pharynx, oxygen saturation, PH, neutrophils, alanine aminotransferase, total bilirubin, etc. (P0.05), namely, P0.05. There was no significant difference between the storage group and the death group; (2) the CT performance comparison showed that there were 4 indexes of GGO, GGO volume, GGO volume ratio and the number of GGO involved in the lung segment (P0.05), there was no significant difference in lung texture, real change, pleural effusion, scanning time and other 5 indexes (P0.05). (3) Logistic regression. The analysis suggested that GGO volume, serum creatinine and Pa O2 were independent prognostic factors (P0.05) for determining the prognosis of paraquat intoxication in 24 hours, Pa CO2, gluten transaminase, and white blood cell count is not an independent prognostic factor (P0.05) to judge the prognosis of paraquat poisoning; (4) the ROC curve indicated that the area under the GGO volume (AUC=0.837) curve is larger than the serum creatinine (AUC=0.832). Pa O2 (AUC=0.739), the GGO volume of CT in the lung (cut-off value of 7.62cc3) within 24 hours of paraquat poisoning, the sensitivity of the patient's death was predicted, the specificity and accuracy were 96.97%, 68%, 74%. (5) GGO, 32.1%, and 80% (P0.05) in no GGO group. The outcome of the poisoned prognosis, but GGO volume has better predictive efficiency and sensitivity, accuracy, that is, GGO within 24 hours of paraquat poisoning, volume size is of objective clinical guiding value for judging the prognosis of paraquat poisoning. To study the prognostic value of the early dynamic changes of the body accumulation of the lung glass shadow in the two paraquat intoxication The relationship between the dynamic changes in the volume of CT glass shadow in the lung and the prognosis of the early (7 days) lung intoxication. Materials and Methods Retrospective analysis of the imaging changes in the patients with complete CT data within 24 hours, 2 days, 4 days and 7 days after paraquat poisoning and the survival group and the death group according to the survival conditions of the patients with paraquat poisoning within 90 days, compared with the survival and death groups. Compared with the characteristics of the dynamic changes of GGO volume in the two groups, the repeated measurement of variance analysis was used to analyze it. Compared with the ROC curve, the mortality was predicted by four time points. 30 cases in the survival group, 12 cases in the death group, and (1) the number of abnormal signs of pulmonary CT in the two groups of the patients had not changed obviously with the time of time. (2) repeated measurements were carried out. The results of the quantitative variance analysis show that the time factor has effect (F=13.458, P=0.001), that is, the volume of GGO changes with time, and the time factor has interaction with the group factor (F=13.436, P=0.001), that is, the GGO volume measured at each time point changes with the group change, and the results of the intergroup factors show that the group factor has effect (F=14.024, P=0.001). There was a statistical difference between the GGO volume between the survival group and the death group. (3) in the group comparison, there was a statistically significant difference between the survival group and the death group at 2 days, 4 days, 7 days and three time points (P0.05), and there was no statistical difference between the survival group and the death group at the 24 hour point of paraquat poisoning (P0.05). The GGO volume of the survival group at the above three time points was obviously lower than the death group, and the GGO volume in the survival group was not much different from the death group at the time point of 24 hours of paraquat poisoning. There was no statistical difference between the four time points in the survival group, and the difference between the time points between the dead groups was statistically significant, that is, the death group. Over time, CT follow-up showed the trend of progressive enlargement of GGO volume; (4) 24 hours of paraquat poisoning, 2 days, 4 days, and 7 days of GGO volume curves were 0.524,0.741,0.798,0.833, showing an increase in the prediction of death sensitivity (33.33%, 83.33%, 91.67%, 91.67%), while specificity (92.86%, 64.29%, 71.43%, 71.43%) Conclusion the GGO volume in the early stage of paraquat poisoning shows a stable prognosis and a rapid increase in the prognosis. The progress indicates that the patient's outcome is bad. The dynamic changes of the GGO volume in the early stage of paraquat poisoning are accurate and objective for predicting the prognosis of paraquat poisoning and have good guidance price for clinical treatment and evaluation. Value.

【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R595.4;R816.41

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 陳曉鳳;寧宗;李凱;曹迪;;百草枯中毒患者肺部CT密度變化與預(yù)后關(guān)系研究[J];中國(guó)全科醫(yī)學(xué);2015年21期

2 李競(jìng);趙繼華;張泉;袁飛;魏路清;;高分辨率CT評(píng)價(jià)磨玻璃密度影對(duì)急性百草枯中毒患者的預(yù)后價(jià)值[J];中華危重病急救醫(yī)學(xué);2015年04期

3 史曉峰;張s，

本文編號(hào)：1809894