中国汶川大地震受难者血清电解质特征
|
摘要
目的分析汶川地震受难者血清电解质异常状况,并探讨其可能的病理机制。方法测定400例受难者(其中挤压伤206例、非挤压伤194例)血清K+,Na+,Cl-,Ca2+,Mg2+和P浓度,其结果经统计学处理。结果挤压伤患者和非挤压伤患者之间各电解质成分均有显著差异。相关关系显示:除Cl--Mg2+和Ca2+-P之间的相关关系从正相关转变为负相关,无显著性差异;Mg2+-P之间从负相关(r=-0.306,P=0.997)转变成正相关(r=0.280,P=0.000),且差异有统计学显著性意义外,其余电解质成分之间在挤压伤和非挤压伤的相关变化基本一致。多元统计分析表明:风险因子最高的是血清K+(OR=28.037),其次为Ca2+(OR=7.284),Cl-(OR=4.457),P(OR=2.754),Na+(OR=1.780)和Mg2+(OR=0.592)。ROC曲线分析结果显示:诊断挤压伤特异度(Sp)最高的是血清K+,为98.5(cutoff=5.8mmol/L),其次是血清P,Sp=84.3(cutoff=1.61mmol/L);灵敏度(Se)最高的是Ca2+(cutoff=1.75mmol/L),Se=81.1,其次是Cl-,Se=78.3(cutoff=90mmol/L);曲线下的面积(AUC)以血清K+最高,为0.859(95可信限:0.819～0.898),其它依次为P,Na+,Cl-,Mg2+和Ca2+,结果分别是0.550(0.494～0.607),0.507(0.450～0.564),0.442(0.386～0.498),0.424(0.368～0.479)和0.358(0.303～0.412)。结论自然灾害发生后,挤压伤患者的血清电解质异常较多见,常规性检测受难者血清电解质对正确评估其体内代谢状况和救护生命很有帮助。
Objective To study the serum electrolyte abnormalities of the victims after the Wenchuan earthquake,as well as to investigate the possible pathogenetic mechanisms responsible for these abnormalities.Methods Serum potassium(K+),sodium(Na+),chlorine(Cl-),calcium(Ca2+),magnesium(Mg2+) and inorganic phosphate(P) concentrations were determined in 400 victims(crush injury 206,non-crush injury 194).Their values were analyzed in statistical methods.Results Significant differences of all determined electrolytes were observed between crush injury and non-crush injury.Pearson correlation analysis showed that correlative change among electrolyte were similar in crush injury patients and non-crush injury patients except the correlation coefficients of Cl--Mg2+ and Ca2+-P changed from positive value into negative value,Mg2+-P changed from negative value(r=-0.306,P=0.997) into positive value(r=0.280,P=0.000).Multivariate logistic analysis revealed that risk factor for K+(OR=28.037) was highest,next was Ca2+(OR=7.284),Cl-(OR=4.457),P(OR=2.754),Na+(OR=1.780) and Mg2+(OR=0.592) in order.Receiver operating characteristics(ROC) curves revealed that the highest specificity for K+(at cut off value 5.8 mmol/L) to diagnose crush injury was 98.5%,the following was P(Sp=84.3%,cut off=1.61 mmol/L).The highest sensitivity was Ca2+(Se=81.1%,cut off=1.75 mmol/L),the second was Cl-(Se=78.3%,cut off=90 mmol/L).The area under the ROC curve(AUC) for K+ was the largest(0.859,95% confidence interval:0.819～0.898),next was P(0.550,0.494～0.607),Na+(0.507,0.450～0.564),Cl-(0.442,0.386～0.498),Mg2+(0.424,0.368～0.479)and Ca2+(0.358,0.303～0.412).Conclusion Electrolyte abnormalities are frequently encountered in conjunction with natural catastrophes victims with crush injury.It may be useful for evaluating electrolyte metabolism in victims'bodies correctly and saving life if the electrolytes were measured routinely.
Objective To study the serum electrolyte abnormalities of the victims after the Wenchuan earthquake,as well as to investigate the possible pathogenetic mechanisms responsible for these abnormalities.Methods Serum potassium(K+),sodium(Na+),chlorine(Cl-),calcium(Ca2+),magnesium(Mg2+) and inorganic phosphate(P) concentrations were determined in 400 victims(crush injury 206,non-crush injury 194).Their values were analyzed in statistical methods.Results Significant differences of all determined electrolytes were observed between crush injury and non-crush injury.Pearson correlation analysis showed that correlative change among electrolyte were similar in crush injury patients and non-crush injury patients except the correlation coefficients of Cl--Mg2+ and Ca2+-P changed from positive value into negative value,Mg2+-P changed from negative value(r=-0.306,P=0.997) into positive value(r=0.280,P=0.000).Multivariate logistic analysis revealed that risk factor for K+(OR=28.037) was highest,next was Ca2+(OR=7.284),Cl-(OR=4.457),P(OR=2.754),Na+(OR=1.780) and Mg2+(OR=0.592) in order.Receiver operating characteristics(ROC) curves revealed that the highest specificity for K+(at cut off value 5.8 mmol/L) to diagnose crush injury was 98.5%,the following was P(Sp=84.3%,cut off=1.61 mmol/L).The highest sensitivity was Ca2+(Se=81.1%,cut off=1.75 mmol/L),the second was Cl-(Se=78.3%,cut off=90 mmol/L).The area under the ROC curve(AUC) for K+ was the largest(0.859,95% confidence interval:0.819～0.898),next was P(0.550,0.494～0.607),Na+(0.507,0.450～0.564),Cl-(0.442,0.386～0.498),Mg2+(0.424,0.368～0.479)and Ca2+(0.358,0.303～0.412).Conclusion Electrolyte abnormalities are frequently encountered in conjunction with natural catastrophes victims with crush injury.It may be useful for evaluating electrolyte metabolism in victims'bodies correctly and saving life if the electrolytes were measured routinely.
引文
[1]Sever MS,Erek E,Vanholder R,et al.The Marmara earthquake:Epidemiological analysis of the victims with nephrological problems[J].Kidney International,2001,60(3):1114-1123.
[2]Slater MS,Mullins RJ.Rhabdomyolysis and myogl-obinuric renal failure in Trauma and surgical patients:a review[J].J Am Coll Surg,1998,186(6):693-716.
[3]Sever MS,Erek E,Vanholder R,et al.The Marmara earthquake:admission laboratory features of patients with nephrological problems[J].Nephrol Dial Transplant,2002,17(6):1025-1031.
[4]Sever MS,Erek E,Vanholder R,et al.Serum potassium in the crush syndrome victims of the Marmara disaster[J].Clin Nephrol.2003,59(5):326-333.
[5]Kishore B,Thurlow V,Kessel B.Hypokalaemic rhabdomyolysis[J].Ann Clin Biochem,2007,44(3):308-311.
[6]Ting JY.Rhabdomyolysis and polydipsic hyponatrae-mia[J].Emerg Med J,2001,18(6):520.
[7]Shiber JR,Mattu A.Serum phosphate abnormalities in the emergency department[J].J Emerg Med,2002,23(4):395-400.
[8]Liamis G,Mitrogianni Z,Liberopoulos EN,et al.El-ectrolyte disturbances in patients with hyponatremia[J].Intern Med,2007,46(11):685-690.
[2]Slater MS,Mullins RJ.Rhabdomyolysis and myogl-obinuric renal failure in Trauma and surgical patients:a review[J].J Am Coll Surg,1998,186(6):693-716.
[3]Sever MS,Erek E,Vanholder R,et al.The Marmara earthquake:admission laboratory features of patients with nephrological problems[J].Nephrol Dial Transplant,2002,17(6):1025-1031.
[4]Sever MS,Erek E,Vanholder R,et al.Serum potassium in the crush syndrome victims of the Marmara disaster[J].Clin Nephrol.2003,59(5):326-333.
[5]Kishore B,Thurlow V,Kessel B.Hypokalaemic rhabdomyolysis[J].Ann Clin Biochem,2007,44(3):308-311.
[6]Ting JY.Rhabdomyolysis and polydipsic hyponatrae-mia[J].Emerg Med J,2001,18(6):520.
[7]Shiber JR,Mattu A.Serum phosphate abnormalities in the emergency department[J].J Emerg Med,2002,23(4):395-400.
[8]Liamis G,Mitrogianni Z,Liberopoulos EN,et al.El-ectrolyte disturbances in patients with hyponatremia[J].Intern Med,2007,46(11):685-690.
版权所有：© 2023 中国地质图书馆 中国地质调查局地学文献中心