血清磷对脓毒症生存状况影响的动态观察研究  

Dynamic observation of the influence of serum phosphorus on the survival of sepsis patients

作　　者：周佾龙[1] 杨韶华[2] 张斌 张弛[1] 杨新娟 乔保国 Zhou Yilong;Yang Shaohua;Zhang Bin;Zhang Chi;Yang Xinjuan;Qiao Baoguo(Department of Emergency,The Sanmenxia Central Hospital of Sanmenxia City;Department of ICU,The Sanmenxia Central Hospital of Sanmenxia City)

机构地区：[1]河南省三门峡市中心医院急诊科,三门峡472000 [2]河南省三门峡市中心医院ICU,三门峡472000

出　　处：《重庆医科大学学报》2019年第1期114-118,共5页Journal of Chongqing Medical University

摘　　要：目的:探讨血清磷浓度动态变化对脓毒症患者生存状况的预测价值。方法:回顾性分析2017年1月至2017年12月于我院进行治疗的92例脓毒症患者的临床资料,根据28 d生存状况将患者分为生存组(63例)与死亡组(29例),死亡率31.52%。收集并比较2组患者的临床资料、APACHEⅡ评分、入重症医学科(intensive care unit,ICU)后第1、3、5、7天血清磷水平,采用受试者工作特征曲线(ROC)评估不同时间血清磷水平、APACHEⅡ评分对脓毒症患者生存状况的预测价值。结果:2组脓毒症患者之间的有创机械通气比例、感染部位分布、入住ICU时间差异无统计学意义(P>0.05);生存组脓毒症患者血管活性药物使用率及APACHEⅡ评分均明显低于死亡组(P<0.05)。2组脓毒症患者入住ICU第1天血清磷水平差异无统计学意义(P>0.05);生存组脓毒症患者的血清磷水平呈逐渐升高的趋势,死亡组脓毒症患者的血清磷水平呈逐渐降低的趋势;生存组毒症患者入住ICU第3、5、7天血清磷水平明显高于死亡组(P<0.05)。其中入住ICU第7天血清磷水平、APACHEⅡ评分AUC分别为0.952和0.830,95%CI为0.912～0.996和0.742～0.915,预测价值较高;而入住ICU第7天血清磷水平截断值为1.02 mmol/L,其对于脓毒症患者生存状况的敏感度与特异度均较高,为92.31%和82.61%,阳性似然比5.31,阴性似然比0.09。结论:生存组脓毒症患者的血清磷水平呈逐渐升高的趋势,而死亡组脓毒症患者的血清磷水平则呈逐渐降低的趋势;入住ICU第7天血清磷水平对于脓毒症患者的生存状况的敏感度与特异度最高,预测价值最大。Objective:To investigate the value of dynamic changes of serum phosphorus concentration in predicting the survival of patients with sepsis. Methods:A retrospective analysis was performed for the clinical data of 92 patients with sepsis who were treated in our hospital from January to December,2017. According to the 28-day survival,the patients were divided into survival group with 63 patients and death group with 29 patients,and the mortality rate was 31.52%. The two groups were compared in terms of clinical data,Acute Physiology and Chronic Health Evaluation Ⅱ(APACHEⅡ) score,and serum phosphorus levels on days 1,3,5,and 7 after admission to the intensive care unit(ICU),and the receiver operating characteristic(ROC) curve was used to evaluate the value of serum phosphorus at different time points and APACHEⅡ score in predicting the survival of patients with sepsis. Results:There were no significant differences in the proportion of patients undergoing invasive mechanical ventilation,the distribution of infection sites,and the duration of ICU stay between the two groups(P >0.05),and the survival group had significantly lower rate of use of vasoactive drugs and APACHE Ⅱ score than the death group(P<0.05). There was no significant difference in serum phosphorus between the two groups on day 1 after admission to the ICU(P >0.05);the survival group had a gradual increase in serum phosphorus,while the death group had a gradual reduction;on days 3,5,and 7 after admission to the ICU,the survival group had a significantly higher serum phosphorus level than the death group(P<0.05). Serum phosphorus level on day 7 after admission to the ICU and APACHEⅡ score had an area under the ROC curve of 0.952(95% confidence interval[CI]:0.912-0.996) and 0.830(95% CI:0.742-0.915),respectively,and thus had a high predictive value. At the cut-off value of 1.02 mmol/L,serum phosphorus level on day 7 after admission to the ICU had a sensitivity of 92.31%,a specificity of 82.61%,a positive likelihood ratio of 5.31,and a negative li

关 键 词：血清 磷 脓毒症 生存状况 

分 类 号：R631[医药卫生—外科学]