血镁与重症血液透析患者死亡的相关性研究  

Study on the correlation between blood magnesium and death in severe hemodialysis patients

作　　者：章佳颖[1] 杨政[2] 马纪林[3] 方堃[1] 孙静[1] 石占利[1] 任丹虹[1] 

机构地区：[1]杭州市红十字会医院重症监护室,浙江杭州310003 [2]浙江中医药大学第二临床医学院,浙江杭州310006 [3]杭州市红十字会医院血液净化中心,浙江杭州310003

出　　处：《中国现代医生》2017年第2期8-11,共4页China Modern Doctor

基　　金：国家自然科学基金(81274161);浙江省科技计划项目(2015C33278)

摘　　要：目的观察重症病房血液透析患者的血镁水平与其生存时间之间的关系。方法统计我院重症病房近5年(2011年1月~2016年5月)行床边血液透析治疗患者92例,记录患者入住我科时行床边血液透析治疗前血镁浓度及其他参数,并记录患者在我中心生存时间,分析患者血镁水平及其他参数与死亡的相关性。结果 92例入选患者中低镁血症(<0.7 mmol/L)28例,正常血镁(0.7~1.2 mmol/L)64例,未见明显高镁血症(>1.2 mmol/L),低镁血症患者占30.43%。死亡组(患者生存时间<28 d)62例,其中低镁血症患者24例,占38.71%;存活组(患者生存时间≥28 d)30例,低镁血症患者4例,占13.33%;与死亡组比较,存活组血镁水平明显偏高(P<0.01),而C-反应蛋白、乳酸及急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分明显偏低(P<0.05)。通过多因素Logistic回归分析发现血液透析治疗患APACHEⅡ评分[优势比(OR)=1.137,95%可信区间(95%CI)=1.033~1.251,P=0.008]和血CRP(OR=1.010,95%CI=1.001~1.019,P=0.024)为影响ICU重症患者死亡的独立危险因素,血镁(OR=0.025,95%CI=0.001~0.528,P=0.018)为影响ICU重症患者死亡的独立保护因素。结论低血镁水平与重症病房床边血液透析治疗的患者高死亡率有关,适当纠正血镁水平可能会延长其生存时间,值得临床关注。Objective To observe the relationship between the blood magnesium level and the survival time of hemodialysis patients in ICU. Methods A total of 92 patients who were given bedside hemodialysis and treated in the ICU of our hospital in recent 5 years from January 2011 to May 2016 were statistically analyzed. The blood magnesium concentration and other parameters were recorded before the treatment of bedside hemodialysis when the patients were admitted to our hospital, and the survival time of the patients in our center was also recorded. The correlation between death and blood magnesium level and other parameters were analyzed. Results Among the 92 included patients, 28 patients were with hypomagnesemia （〈0.7 mmol/L）, and 64 patients were with normal blood magnesium （0.7 to 1.2 retool/L）. No significant hypermagnesemia （〉1.2 retool/L） was observed, and the patients with hypomagnesemia accounted for 30.43%. 62 patients were in the death group（patients＂ survival time 〈28 days）, among whom 24 cases were hypomagne- semia, accounting for 38.71%; 30 patients were in the survival group （survival time ≥28 days）, among whom 4 patients were hypomagnesemia, accounting for 13.33%; compared with the death group, the level of blood magnesium in the survival group was significantly higher （P〈0.O1）. The levels of C-reactive protein, lactic acid and acute physiology and chronic health status system Ⅱ （APACHE Ⅱ ） were significantly lower （P〈0.05）. According to multivariate Logistic regres- sion analysis, APACHE U score（OR=l.137, 95%CI=1.033-1.251, P=O.008） and blood CRP（OR=I.010, 95%CI=1.001- 1.019, P=0.024） were independent risk factors for death in critical patients in ICU. Blood magnesium （OR=0.025, 95% CI=0.001-0.528, P=0.018） was an independent protective factor for death in critical patients in ICU. Conclusion The level of hypomagnesemia is related to the high death rate of bedside hemodialysis patients in ICU. Appropriate correc- tion of blood magnesium levels ma

关 键 词：血液透析 血清镁 重症患者 低镁血症 生存时间 

分 类 号：R692.5[医药卫生—泌尿科学]