中重度颅脑损伤患者早期血磷水平与近期预后的相关性分析  

Analysis on the Correlation of Early Blood Phosphorus Levels and Recent Prognosis of Patients with Moderate or Severe Brain Injury

作　　者：杨生军[1] 郭杰[1] 赵开胜[1] 郝文炯[1] 张春满[1] 

机构地区：[1]延安大学附属医院神经外科,陕西延安716000

出　　处：《现代生物医学进展》2016年第29期5699-5702,共4页Progress in Modern Biomedicine

基　　金：陕西省教育厅科学技术研究项目(2011658)

摘　　要：目的:探讨中重度颅脑损伤患者早期血磷水平与近期预后的相关性。方法:将97例中重度颅脑损伤患者按照入院后24 h内的血磷水平分为低磷血症组(n=23例,血磷<0.80 mmol/L)和正常血磷组(n=74例,血磷≥0.80 mmol/L);记录患者入院后28 d的预后情况,按照是否死亡分为死亡组及存活组,比较两组相关指标的差异。用Logistic回归方程分析血磷水平与患者死亡的关系,应用ROC曲线评估血磷水平预测患者死亡的临床价值。结果:与血磷正常组比较,低磷血症组患者发病至入院时间较长、入院时血压及GCS评分较低、入院APACHEⅡ评分较高,死亡率偏高(P<0.05);死亡组患者入院GCS评分低于存活组,而APACHEⅡ评分高于存活组(P<0.05);血磷水平及低磷血症的发生率高于存活组(P<0.05),多因素Logistic回归方程分析提示:血磷降低是中重度颅脑损伤患者入院28d后死亡的独立危险因素(P<0.05)。血磷水平(≤0.68 mmol/L)预测患者死亡的曲线下面积(ROCAUC)分别为:0.889;灵敏度和特异度分别为:83.9%;77.6%。最佳诊断截点为0.68 mmol/L。结论:血磷水平降低可能是中重度颅脑损伤患者近期死亡的独立危险因素,早期检测血磷水平对评估患者近期预后具有一定的临床意义。Objective： To explore the correlation between the early blood phosphorus levels of craniocerebral injury patients and their recent prognosis. Methods： 97 patients with moderately severe craniocerebral injury were divided into low phosphorus concentration groups （n=23, the blood phosphorus 〈 0.80 mmol/L） and normal phosphorus concentration group （n=74, the blood phosphorus ≥ 0.80 mmol/L） according to the blood phosphorus levels within 24 h after admission. Recorded the prognosis of patients 28 d after admission, and divided them into death group and survival group. Compared the difference of related indicators between groups. Logistic regression equation analysis was applied to investigate the relationship of blood phosphorus levels and death, and ROC curve was applied to evalu- ate the clinical value of blood phosphorus levels in predicting death. Results： Compared with normal blood phosphorus group, low blood phosphorus group had long hospital time, low blood pressure and low GCS score on admission, high APACHE II score on admission and high mortality （P〈0.05）. Patients in death group had lower GCS score on admission, but higher APACHE II score than those in sur- vival group （P〈0.05）. The incidence of low phosphorus concentration was higher in death group than in survival group （P〈0.05）. Mul- ti-factor Logistic regression equation analysis indicated that lower blood phosphorus level was the independent risk factors of death for moderately-severe craniocerebral injury patients 28 d after admitted to hospital （P〈0.05）. ROC curve analysis showed that ROCAUC of blood phosphorus levels （≤ 0.68 mmol/L） in death prediction were 0.889, and the sensitivity and specific degrees were respectively 83.9%; and 77.6%. The best diagnostic cutoff point was 0.68 mmol/L. Conclusion： Low blood phosphorus levels may be an independent risk factors for recent death of moderately-severe craniocerebral injury patients. Early detection of blood phosphorus levels had clinical significance

关 键 词：低磷血症 颅脑损伤 预后 

分 类 号：R651.1[医药卫生—外科学]