早期低磷血症对重症患者预后的影响
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摘要
目的观察ICU早期低磷血症的发生率及对医院生存率的影响。方法2017年1-12月ICU患者,记录24 h内血磷水平、APACHEⅡ评分。将所有患者分为轻、中、重度低血磷症组和正常血磷组。观察早期低磷血发生率、各组间医院生存率。比较生存、死亡组血磷水平、APACHEⅡ评分。结果105例患者,低血磷43例,正常62例,低血磷发生率40.95%,轻度低血磷18例、中度21例、重度4例。低血磷组医院生存率较正常组低,血磷水平越低医院生存率越低。低血磷组APACHEⅡ评分较正常组高,APACHEⅡ评分与血磷水平呈显著负相关,血磷水平越低APACHEⅡ评分越高。105例患者生存55例,死亡50例,生存组的中位数血磷水平为0.960 mmol/L,死亡组的中位数血磷水平0.675 mmol/L,生存组较死亡组血磷水平高。结论重症患者早期易发生低血磷,血磷水平是重症患者预后指标之一。
Objective To investigate the incidence of early hypophosphatemia in ICU and its effect on hospital survival rate.Methods From January to December 2017, the levels of blood phosphorus and APACHEII scores in 24 hours were recorded in ICU patients. All patients were divided into mild, moderate and severe hypophosphatemia group and normal blood phosphorus group. The incidence of early hypophosphatemia and the hospital survival rate among groups were observed. The blood phosphorus levels and APACHE Ⅱ scores in survival and death groups were compared. Results Among 105 patients, 43 patients were hypophosphatemia, 62 patients were normal, the incidence of hypophosphatemia was 40.95%, 18 patients were mild hypophosphatemia,21 patients were moderate hypophosphatemia and 4 patients were severe hypophosphatemia. The hospital survival rate of the low blood phosphorus group was lower than that of the normal group, and the lower the blood phosphorus level was, the lower the hospital survival rate was. The APACHE Ⅱ score in the hypophosphatemia group was higher than that in the normal group. The APACHE Ⅱ score was negatively correlated with the blood phosphorus level. The lower the blood phosphorus level, the higher the APACHE Ⅱ score. Of 105 patients, 55 survived and 50 died. The median blood phosphorus level in survival group was 0.960 mmol/L, while that in death group was 0.675 mmol/L. The level of blood phosphorus in survival group was higher than that in death group. Conclusion Critically ill patients are prone to be hypophosphoremia in the early stage and serum phosphate level is the prognostic indicator for them.
Objective To investigate the incidence of early hypophosphatemia in ICU and its effect on hospital survival rate.Methods From January to December 2017, the levels of blood phosphorus and APACHEII scores in 24 hours were recorded in ICU patients. All patients were divided into mild, moderate and severe hypophosphatemia group and normal blood phosphorus group. The incidence of early hypophosphatemia and the hospital survival rate among groups were observed. The blood phosphorus levels and APACHE Ⅱ scores in survival and death groups were compared. Results Among 105 patients, 43 patients were hypophosphatemia, 62 patients were normal, the incidence of hypophosphatemia was 40.95%, 18 patients were mild hypophosphatemia,21 patients were moderate hypophosphatemia and 4 patients were severe hypophosphatemia. The hospital survival rate of the low blood phosphorus group was lower than that of the normal group, and the lower the blood phosphorus level was, the lower the hospital survival rate was. The APACHE Ⅱ score in the hypophosphatemia group was higher than that in the normal group. The APACHE Ⅱ score was negatively correlated with the blood phosphorus level. The lower the blood phosphorus level, the higher the APACHE Ⅱ score. Of 105 patients, 55 survived and 50 died. The median blood phosphorus level in survival group was 0.960 mmol/L, while that in death group was 0.675 mmol/L. The level of blood phosphorus in survival group was higher than that in death group. Conclusion Critically ill patients are prone to be hypophosphoremia in the early stage and serum phosphate level is the prognostic indicator for them.
引文
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[12]林书生,赵开萌,蒋福初.重症监护病房患者低磷血症的临床分析[J].中国医药指南,2014,12(15):29-30.
[13]闫欣桐,王燕宏,栗洁婷,等.NICU患者肠内营养支持时低磷血症与预后的相关分析[J].临床医药文献电子杂志,2018,5(11):76-77.
[14]冯彦翔,晏春生,龙芬.慢性阻塞性肺病(COPD)并呼吸衰竭患者血清磷水平的临床意义分析[J].系统医学,2018,3(4):79-81.
[2]彭碧云,李君,姚伟,等.重症监护病房患者早期低磷血症对预后的影响[J].淮海医药,2015,33(3):266-267.
[3]谢荣裕.低磷血症对重症监护病房患者预后的影响[J].中国现代药物应用,2014,8(24):56-57.
[4]张晓丽,曲彦,黄建波.不同致病菌所致脓毒症患者低磷血症的临床研究[J].中华急诊医学杂志,2014,23(5):558-561.
[5]刘博,程玉梅,沈锋,等.低磷血症与重症患者不良预后有关:一项1 555例患者的Meta分析[J].中华危重病急救医学,2018,30(1):34-40.
[6]Valentina Pistolesi,Laura Zeppilli,Francesca Polistena,et al.Preventing Continuous Renal Replacement Therapy-Induced Hypophosphatemia:An Extended Clinical Experience with a Phosphate-Containing Solution in the Setting of Regional Citrate Anticoagulation[J].Blood Purification,2017,44(1):8-15.
[7]Saito Y,Aoki Y,Takeshita E,et al.Hypophosphatemia is a common complication in severely disabled individuals with neurological disorders and is caused by infection,refeeding and Fanconi syndrome[J].Brain Dev,2014,36(10):878-883.
[8]Zoller H,Schaefer B,Glodny B.Iron-induced hypophosphatemia:an emerging complication[J].Curr Opin Nephrol Hypertens,2017,26(4):266-275.
[9]张建群.低磷血症在危重症患者中的临床意义及研究进展[J].中国现代药物应用,2014,8(12):240-242.
[10]Narayan A,Subramanian A.Severe hypophosphataemia:a rare cause of postoperative muscle weakness[J].BMJ Case Rep,2018,23:2018.
[11]Reihanak,Talakoub Mahshid,Bahrami Azim,et al.The Predicting Ability of Serum Phosphorus to Assess the Duration of Mechanical Ventilation in Critically Ill Patients[J].Advanced Biomedical Research,2017(1):51.
[12]林书生,赵开萌,蒋福初.重症监护病房患者低磷血症的临床分析[J].中国医药指南,2014,12(15):29-30.
[13]闫欣桐,王燕宏,栗洁婷,等.NICU患者肠内营养支持时低磷血症与预后的相关分析[J].临床医药文献电子杂志,2018,5(11):76-77.
[14]冯彦翔,晏春生,龙芬.慢性阻塞性肺病(COPD)并呼吸衰竭患者血清磷水平的临床意义分析[J].系统医学,2018,3(4):79-81.