低磷血症对严重多发伤患者机械通气撤机后炎症因子变化及预后的影响

A study on the impact of hypophosphatemia on inflammatory factors and prognosis of severe multiple injury patients undergoing mechanical ventilation withdrawal

目的探究低磷血症对严重多发伤患者机械通气撤机后炎症因子变化及预后的影响。方法回顾性分析2020年12月至2021年12月本院收治的多发伤患者78例的临床资料,根据患者实验室生化检测血磷水平将患者分为低血磷组31例和正常血磷组48例。观察两组患者的炎症指标:血清降钙素原(PCT)、血清白细胞介素(IL-6)、C反应蛋白(CRP)。观察两组患者的医疗干预措施、病死率和撤离机械通气的情况。结果比较两组患者的炎症指标,低血磷组患者的PCT、IL-6和CRP均高于正常血磷组,差异具备统计学意义,P<0.05。比较两组患者的医疗干预措施和患者的死亡率,低血磷组患者的采用肠外营养的概率和死亡率均高于正常血磷组,而撤离机械通气率小于正常血磷组,差异具备统计学意义,P<0.05;而两组患者使用呼吸机辅助呼吸的概率和使用血液滤过的概率比较差异无统计学意义(P>0.05)。比较两组患者的PI和PVI的情况,正常血磷组的PI高于高血磷组,PVI低于高血磷组,差异具备统计学意义(P<0.05)。结论低磷血症严重影响严重多发伤患者的预后情况,对于患者的炎症指标、干预措施、生存和机械通气的撤离均具备一定的负面影响,在临床实践中值得注意。

Objective To explore the impact of hypophosphatemia on inflammatory factors and prognosis of severe multiple injury patients undergoing mechanical ventilation withdrawal.Methods The clinical data of 78 patients with multiple injuries admitted to our hospital from December 2020 to December 2021 were analyzed retrospectively.The patients were divided into 31 cases of low blood phosphorus group and 48 cases of normal blood phosphorus group according to the level of blood phosphorus detected by laboratory biochemistry.The inflammatory indexes of the two groups were observed:serum procalcitonin(PCT),serum interleukin(IL-6)and C-reactive protein(CRP).The medical intervention,mortality and mechanical ventilation withdrawal were observed.Results Compared with the inflammatory indexes of the two groups,the PCT,IL-6 and CRP of the patients in the low blood phosphorus group were higher than those in the normal blood phosphorus group,and the difference was statistically significant(P<0.05).The medical intervention measures and mortality of the two groups were compared.The probability and mortality of parenteral nutrition in the low blood phosphorus group were higher than those in the normal blood phosphorus group,while the evacuation rate of mechanical ventilation was lower than that in the normal blood phosphorus group,with a statistically significant difference(P<0.05).However,there was no significant difference between the two groups in the probability of using ventilator to assist respiration and the probability of using hemofiltration(P>0.05).The PI and PVI of the two groups were compared.The PI of the normal blood phosphorus group was higher than that of the high blood phosphorus group,and the PVI was lower than that of the high blood phosphorus group.The difference was statistically significant(P<0.05).Conclusion Hypophosphatemia seriously affects the prognosis of patients with severe multiple injuries,and has a certain negative impact on inflammatory indicators,intervention measures,survival and mechanical ventilation evacuation of patients,which should be noted in clinical practice.