初始血清钙离子浓度对ICU严重创伤患者病情及预后的预测价值

Value of initial serum ionized calcium concentration in evaluating disease condition and prognosis of severe trauma in ICU

目的 探讨初始低钙血症水平对ICU严重创伤患者预后的预测价值.方法 选取2015年1月至2018年12月遵义市第一人民医院ICU创伤患者117例,根据初始离子钙浓度(iCa)分组,其中钙离子正常组18例(iCa≥1.12 mmol/L)、低钙血症组74例(0.90≤iCa<1.12 mmol/L)、严重低钙血症组25例(iCa<0.90 mmol/L).比较各组患者创伤严重度评分(ISS评分)、APACHEⅡ评分、是否需大量输血方案、ICU住院时间和28 d死亡率的差异.结果 三组患者的性别、年龄及创伤类型(钝挫伤、贯穿伤及其他)比较差异均无统计学意义(P>0.05);低钙血症组与钙离子正常组的ISS评分[(34.9±8.7)分vs(27.3±5.1)分]、APACHEⅡ评分[(19.2±6.7)分vs(15.6±3.4)分]、需要大量输血方案比例(24%vs 0)、ICU住院时间[(9.1±3.1)d vs(3.6±1.3)d]及28 d死亡率(20%vs 0)比较,低钙血症组明显高于钙离子正常组,差异均有统计学意义(P<0.05);严重低钙血症组与低钙血症组患者的ISS评分[(40.2±8.2)分vs(34.9±8.7)分]、APACHEⅡ评分[(23.8±8.0)分vs(19.2±6.7)分]、需要大量输血方案比例(48%vs 24%)及28 d死亡率(44%vs 20%)比较,严重低钙血症组明显高于低钙血症组,差异均具有统计学意义(P<0.05).结论 创伤患者常合并低钙血症,钙离子浓度越低,病情越严重、死亡率越高;初始离子钙浓度水平可作为早期预测创伤患者病情及预后的参考指标.

Objective To investigate the value of initial serum ionized calcium concentration in evaluating prognosis of severe trauma in ICU.Methods A total of 117 patients with severe trauma,who admitted to ICU of Zunyi First People's Hospital from January 2015 to December 2018,were selected as the research subjects.According to initial serum ionized calcium concentration,the patients were divided into three groups,including normal calcium ions group(iCa≥1.12 mmol/L,n=18),hypocalcemia group(0.90 mmol/L≤iCa<1.12 mmol/L,n=20)and severe hypocalcemia group(iCa<0.90 mmol/L,n=25).The differences of the trauma Injury Severity Score(ISS),Acute Physiology and Chronic Health Evaluation(APACHE)Ⅱ,whether was given a large number blood transfusion,duration of hospitalization of ICU,and the mortality rate of 28 days were compared among the three groups.Results There was no significant difference in sex,age and type of trauma(contusion,penetration injury and others)among the three groups(all P>0.05).ISS score,APACHEⅡscore,the percent of patients given a large number blood transfusion,duration of hospitalization of ICU,mortality rate of 28 days in the hypocalcemia group were 34.9±8.7,19.2±6.7,24%,(9.1±3.1)d,20%,respectively,which were significantly higher than corresponding 27.3±5.1,15.6±3.4,0,(3.6±1.3)d,0 in normal calcium ions group(all P<0.05);the ISS score,APACHEⅡscore,the percent of patients given a large number blood transfusion,mortality rate of 28 days in the hypocalcemia group were significantly lower than corresponding 40.2±8.2,23.8±8.0,48%,44%in the severe hypocalcemia group(all P<0.05).Conclusion Hypocalcemia is often complicated with trauma,and lower serum ionized calcium concentration is associated with more serious disease condition and higher mortality,and the level of initial ionized calcium concentration can be used as a reference index for early evaluating the disease condition and prognosis of severe trauma.