连续性静脉-静脉血液滤过中低磷血症的防治初探

Preliminary prevention and cure of hypophosphatemia during continuous venovenous hemofiltration

目的对危重患者应用连续性静脉-静脉血液滤过（CVVH）治疗过程中低磷血症的防治进行初步分析与探讨。方法选择危重患者30例，按急性生理与慢性健康评分（APACHEⅡ评分）不同分为2组（〈15分13例为A组，≥15分17例为B组）。两组均行CVVH治疗，置换液速度A组2000ml／h、B组4000ml／h，持续时间8～12h／d；补充甘油磷酸钠A组10～20ml／d，B组为30～40ml／d；治疗前、24小时、48小时、72小时检测血清磷的浓度、进行APACHEⅡ评分，井作血磷与APACHⅡ评分的相关分析，计算磷清除率。结果B组磷清除率大于A组[（42．76±2．39）ml／min vs （23．84±3．05）ml／min，P〈0．05]；治疗前B组血磷浓度低于A组[（0．78±0．19）mmol／L vs（1．25±0．27）mmol／L，P〈0．05]；第24小时两组血磷浓度均开始下降．补磷后第48小时A组血磷浓度正常，B组为轻度低磷血症，经调整补磷剂量后，第72小时恢复正常；CVVH治疗后两组患者APACHEⅡ评分均有降低的趋势；血磷与APACHEⅡ评分的相关分析提示两者呈负相关。结论危重患者易发生低磷血症，且与病情危重程度相关，采用CVVH治疗更易加重低磷血症，补磷应做到个体化，且不必拘泥于常规剂量限制。同时通过密切监测血磷变化来调整。

Objective To approach and investigate the prevention and cure of hypophosphatemia for critically ill patients during continuous venovenous hemofiltration（CVVH）. Methods Thirty critically ill patients enrolled were divided into two groups according to APACHE Ⅱ score. Thirteen patients whose score was less than fifteen were in group A, seventeen patients whose score was more than fifteen were in group B. The mode of CVVH was used in both groups . The rate of replacement fluid in group A was 2 000 ml/h,and in group B 4 000 ml/h, therapy time lasted for eight to twelve hours a day. Group A patients were supplemented with glycophos 10-20 ml/d,while group B patients were with glycophos 30- 40 ml/d. The level of serum phosphorus and APACHEⅡ score were measured before treatment and at the twenty-fourth hour, forty-eighth hour,seventy-seeond hour during therapy. The correlate analysis between serum phosphorus and APACHEⅡ seore was performed and the clearance of phosphorus was figured out. Results The phosphorus clearance of group B was larger than that of group A [（42.76±2.39） ml/min vs （23.84±3.05） ml/min, P〈0. 05]. Before therapy, the serum level of phosphorus of B group was lower than that of A group [（0. 78±0.19） mmol/L vs （1.25±0.27） retool/L, P 〈 0.05]. At the twenty-fourth hour, the level of serum phosphorus of the two groups was decreased. After 24 hours of adding glyeophos, the serum level phosphorus of group A was normal and that of group B was slight hypophosphatemia. After adjusting the dose of glycophos, the level of serum phosphorus of group B was normal at the seventy-second hour. APACHE Ⅱ score in both groups had the trend of decrease after CVVH. Serum phosphorus and APACHE Ⅱ seore had direct negative correlation. Conclusion Hypophosphatemia often occurs in critically ill patients and has direct correlation with severity of illness,while CVVH aggravates hypophosphatemia. So the supplement of phosphorus has individualization and does not adhere to the routine dose, meanwhile the level of serum phosphorus should be monitored closely to adjust the dose of glyeophos.