低磷血症对机械通气患者预后的影响

Effect of the hypophosphatemia on the prognosis of patients receiving mechanical ventilation

目的研究血磷水平对重症监护室机械通气患者临床预后的影响。方法回顾性分析海军总医院重症医学科2012年1月1日—2012年12月31日收治的152例机械通气患者,记录其年龄、性别、原发疾病、28 d内非机械通气时间、重症监护室住院时间、简化急性生理学评分Ⅱ(simply acute physiology scoreⅡ,SAPSⅡ)、急性生理学及慢性健康状况评分Ⅱ(acute physiology and chronic health evaluation scoreⅡ,APACHEⅡ)、临床结局、入重症监护室24 h内血磷值(Pi24 h)及住院期间最低血磷值(Pilow)等临床资料。根据临床结局分为死亡组和存活组,进行组间比较。采用多因素Logistic回归分析和受试者工作特征曲线,评价各种因素对预测患者预后的意义。结果共纳入152例;其中,死亡23例,病死率15.13%。两组间血源性感染、急性脑卒中、APACHEⅡ、预期病死率、SAPSⅡ、非机械通气时间、Pilow差异具有统计学意义(P<0.05)。多因素Logistic回归分析提示APACHEⅡ和Pilow机械通气患者预后不良的独立危险因素。结论严重低磷的机械通气患者,病情较重,预后较差。APACHEⅡ和Pilow可以作为评价机械通气患者预后的指标。

Objective This study investigated the effect of the concentration of serum phos-phate on the prognosis of patients with mechanical ventilation.Methods One hundred and fifty two patients receiving mechanical ventilation admitted to ICU from from January 1 st to December 3 1 st 2012 were enrolled.The patient′sage,gender,primary diseases,duration of without mechanical ventilation,length of ICU stay,simply acute physiology score Ⅱ(SAPSⅡ),acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,clinical outcome,the lowest concentration of serum phosphate in first 24 hr and during hospital stay were recorded.All cases were divided into two groups according to the clinical outcome of the patients.Multiple logistic regression analyses and re-ceiver operating characteristic curve (ROC curve)were performed to assess the association between the factors and the mortality.Results Of the 152 cases analyzed,the overall mortality was 15.13%(23/152)within hospital stay.The results demonstrated that the rate of blood stream infection and acute stroke,APACHE Ⅱ score,expected mortality,SAPSⅡ score of the non-survival group were higher than these of survival group (P<0.05 ).The duration of without mechanical ventilation was shorter in the non-survival group (P<0.05).The lowest serum phosphate concentration in total hos-pital stay was higher in survival group (P<0.05 ).The multiple logistic regression analysis further indicated that the factors Pilow and APACHE Ⅱscore forecast a poor prognosis for the patients with mechanical ventilation.Conclusion The Pilow and APACHE Ⅱscore are correlated to the prognosis of patients receiving mechanical ventilation,they may serve as an mortality predictor in these pa-tients.