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南京医科大学学报(自然科学版) 第43卷第12期
·1650 · Journal of Nanjing Medical University(Natural Sciences) 2023年12月
·临床研究·
急性硫化氢中毒合并中枢神经系统损伤的相关危险因素及其
预测价值研究
王 瑶 ,张劲松 ,范博文 ,何 斌 ,张华忠 ,孙 昊 ,方 熙 ,陈 科 ,郭世光 ,吴 昊 1*
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南京医科大学第一附属医院急诊与危重病医学科,江苏 南京 210029;南京医科大学公共卫生学院现代毒理学教育部重
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点实验室,江苏 南京 211166;溧阳市人民医院急诊科,江苏 常州 213300;南京医科大学附属淮安第一医院 ICU,江
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苏 淮安 223300
[摘 要] 目的:探讨急性硫化氢(hydrogen sulfide,H2S)中毒合并中枢神经系统(central nervous system,CNS)损伤的相关风险
因素及其预测价值。方法:收集2018年1月1日—2023年4月30日多家医院就诊的急性H2S中毒中至重度患者。根据是否合
并CNS损伤,分析性别、年龄、实验室检验结果以及30 d的死亡、神经功能预后等,探究急性H2S中毒合并CNS损伤的相关危险
因素;采用受试者工作特征(receiver operating characteristic curve,ROC)曲线分析乳酸(lactate,Lac)和神经元特异性烯醇化酶
(neuron specific enolase,NSE)预测急性H2S中毒合并CNS损伤的效能。结果:与非合并CNS损伤组相比,合并CNS组H2S暴露
浓度更高,入院时收缩压、中位格拉斯哥昏迷评分(Glasgow coma scale,GCS)、氧合指数均显著下降,心率显著上升。CNS损伤
组入院后并发急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)、心肌损伤明显增多;30 d死亡率达50%,且改良
Rankin 量表>2分的患者数量显著增高。此外,通过分析发现合并CNS损伤组入院时Lac和NSE水平较非损伤组明显升高,差
异均有统计学意义。ROC曲线显示联合Lac和NSE在预测急性H2S中毒合并CNS损伤的效能优于单个指标,曲线下面积(area
under curve,AUC)达0.948。结论:急性H2S中毒合并CNS损伤患者并发ARDS、心肌损害增加,30 d死亡率增加和神经功能预
后差;此外,急性H2S中毒联合早期血清Lac以及NSE水平的升高判断急性H2S中毒合并CNS损伤具有较高的临床价值。
[关键词] 硫化氢;中毒;中枢神经系统损伤;回顾性研究
[中图分类号] R595 [文献标志码] A [文章编号] 1007⁃4368(2023)12⁃1650⁃07
doi:10.7655/NYDXBNS20231205
Research on the related risk factors and predictive value ofacutehydrogen sulfide
poisoning combined with central nervous system injury
WANG Yao ,ZHANG Jinsong ,FAN Bowen ,HE Bin ,ZHANG Huazhong ,SUN Hao ,FANG Xi ,CHEN Ke ,
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GUO Shiguang ,WU Hao
1 Department of Emergency and Critical Care Medicine,the First Affiliated Hospital of Nanjing Medical University,
Nanjing 210029;Center for Global Health,the Key Laboratory of Modern Toxicology,Ministry of Education,School
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of Public Health,Nanjing Medical University,Nanjing 211166;Department of Emergency,Liyang People’s
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Hospital,Changzhou 213300;ICU,Huai’an First Hospital Affiliated to Nanjing Medical University,Huai’an
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223300,China
[Abstract] Objective:To explore the related risk factors and predictive value ofacute hydrogen sulfide(H2S)poisoning combined
withcentral nervous system(CNS)injury. Methods:Acute H2S poisoning patients withmoderate to severe conditions who were treated in
multiple hospitals from January 1,2018,to April 30,2023 were recruited. Based on whether CNS injury was present,the gender,age,
laboratory test results,30⁃day mortality,and neurological function prognosis were analyzed to investigatethe relevant risk factors for
acute H2S poisoning combined withCNS injury. The receiver operating characteristic(ROC)curve was used to analyze the efficacy of
Lactate(Lac)and neuron⁃specific enolase(NSE)in predicting acute H 2S poisoning combined with CNS injury. Results:Compared with
[基金项目] 国家自然科学基金(82272244)
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通信作者(Corresponding author),E⁃mail:drwuhao@njmu.edu.cn