大手术重症患者血浆钙离子水平的变化及临床意义

Changes of the Levels of Plasma Calcium and Their Clinical Significance in the Critically ill Patients with a Major Operation

目的研究重症患者大手术前后血浆钙离子(Ca2+)水平的变化,并探讨其临床意义。方法回顾性分析65例重症患者大手术前后血浆Ca2+和Na+水平的变化,并与30例正常人作比较。结果重症患者血浆Ca2+的水平明显低于正常人(P<0.001);死亡组血浆Ca2+水平明显低于生存组(P<0.05);大手术后患者血浆Ca2+的水平明显低于术前(P<0.001);血浆Na+水平在以上比较中均无明显差异(P>0.05);术后低Ca2+血症的发生率为95.4%,术前为72.3%,前者明显高于后者(P<0.001);Ca2+水平下降幅度与术中出血量呈正相关(P<0.001)。结论低Ca2+血症广泛存在于危重病人中;大手术可致患者血浆Ca2+水平进一步下降,术中大出血可能是血Ca2+下降的重要原因,而低血Ca2+可能加重术中出血;血浆Ca2+水平可作为估计重症患者预后的指标。

Objective To investigate the changes of the levels plasma calcium （pCa^2＋） and their clinical significance in the critically ill patients with a major operation. Methods A retrospective analysis was made based on 30 healthy individuals and 65 critically ill patients with a major operation, which the levels of pCa^2＋ and plasma sodium （pNa^＋） had been measured. The changes of their levels in the patients before and after operation were assessed. Results There were lower pCa^2＋ for the critically ill patients with a major operation as compared with the control group （P〈0.001）. The death group of the critically ill patients had lower pCa^2＋ as compared with the survival one （P 〈0.05）. The postoperative patients had lower pCa^2＋ as compared with the preoperative ones（p〈0. 001）. However, there was no significantly different levels for pNa^＋ in the above compare（P〈0. 05）. The rate of hypocalcemia in the postoperative patients was 95.4% was higher than the preoperative ones, which was 72.3%（P〈0.001）.A significantly positive correlation was found between the decreases of levels of pCa^2＋ and the count of bleeding during the operation （P〈0. 001）. Conclusion Hypocalcemia commonly exists in the critically ill patients. Major operation may decrease the levels of the critically ill patients, and major bleeding during the operation may be an important cause. On the other hand, hypocalcemia may increase the count of bleeding during the operation. The level of pCa^2＋ may be a predictor of prognosis for the critically ill patients.