Bahloul Mabrouk, Bouaziz Mounir, Dammak Hassen, Ben Hamida Chokri, Ksibi Hichem, Rekik Noureddine, Chelly Hedi, Teboul Jean Louis, Kallel Hatem
Service de Réanimation médicale, CHU Habib Bourguiba, Route el Ain Km 1, 3029 Sfax Tunisia.
Intensive Care Med. 2002 Nov;28(11):1600-5. doi: 10.1007/s00134-002-1480-6. Epub 2002 Sep 6.
To investigate the value of measuring total plasma protein and hemoglobin concentrations for the diagnosis of pulmonary edema secondary to scorpion envenomation.
Retrospective study over a 4-year period in the medical intensive care unit of a university hospital.
67 patients older than 3 years admitted in the intensive care unit for scorpion envenomation and stratified into two groups according to the presence of pulmonary edema assessed by a medical committee that took into account clinical, radiological, and blood gas data at admission and after treatment. Total plasma protein and hemoglobin concentrations were analyzed separately.
At admission all patients with and without pulmonary edema exhibited polypnea and tachycardia. The mean plasma protein and hemoglobin concentrations were higher in patients with pulmonary edema (74+/-6 and 14.2+/-2.0 g/dl, respectively) than in those without pulmonary edema (64+/-6 and 12.3+/-1.4 g/dl). After 24 h plasma protein and hemoglobin concentrations decreased in the pulmonary edema group (-11 and -1.9 g/dl) despite a negative fluid balance (-500 ml). A plasma protein concentration of 70 g/l or more predicted the presence of pulmonary edema with a sensitivity of 80% a specificity of 96%, a positive predictive value of 97%, and negative predictive value of 77%.
In scorpion-envenomed patients with cardiorespiratory manifestations high plasma protein and hemoglobin concentrations suggest the presence of pulmonary edema.
探讨测定血浆总蛋白和血红蛋白浓度对诊断蝎蜇伤继发肺水肿的价值。
对一家大学医院重症监护病房4年期间进行的回顾性研究。
67例3岁以上因蝎蜇伤入住重症监护病房的患者，根据医学委员会评估的肺水肿情况分为两组，该委员会综合考虑了入院时及治疗后的临床、放射学和血气数据。分别分析血浆总蛋白和血红蛋白浓度。
入院时，所有有或无肺水肿的患者均表现为呼吸急促和心动过速。肺水肿患者的平均血浆蛋白和血红蛋白浓度（分别为74±6和14.2±2.0 g/dl）高于无肺水肿患者（64±6和12.3±1.4 g/dl）。24小时后，尽管液体平衡为负（-500 ml），肺水肿组的血浆蛋白和血红蛋白浓度仍下降（分别下降11和1.9 g/dl）。血浆蛋白浓度≥70 g/l可预测肺水肿的存在，敏感性为80%，特异性为96%，阳性预测值为97%，阴性预测值为77%。
在有心肺表现的蝎蜇伤患者中，血浆蛋白和血红蛋白浓度升高提示存在肺水肿。
