动态血磷水平监测在中重度颅脑损伤患者预后评估中的应用价值  

Clinical value of dynamic monitoring of blood phosphorus level in evaluating prognosis of patients with moderate and severe craniocerebral injury

作　　者：张杰[1] 黄卫东[1] 曹杰[1] ZHANG Jie;HUANG Weidong;CAO Jie(Department of Neurosurgery,Shaanxi Provincial People’s Hospital,Xi’an 710068,China)

机构地区：[1]陕西省人民医院神经外科,陕西西安710068

出　　处：《陕西医学杂志》2021年第2期188-191,共4页Shaanxi Medical Journal

基　　金：陕西省自然科学基础研究计划项目(2016JM8073)。

摘　　要：目的:探讨中重度颅脑损伤患者动态血磷水平监测在评估预后转归中的临床价值。方法:回顾性收集122例中重度颅脑损伤患者的临床资料,采用格拉斯哥预后评分(GOS)对患者入院后3个月时的预后进行评估,并分为预后不良组(n=42例)和预后良好组(n=80例)。收集两组患者一般资料及动态血磷水平的变化。以Logistic回归方程分析患者预后不良的相关因素,并以受试者工作特征(ROC)曲线分析血磷水平对患者预后不良的预测价值。结果:预后不良组入院格拉斯哥昏迷评分(GCS)、血清白蛋白水平明显低于预后良好组,入院24 h内颅内压、血肌酐、血清C反应蛋白(CRP)均高于预后良好组,差异具有统计学意义(均P<0.05)。预后不良组入院第3、7天的血磷水平显著低于预后良好组,低磷血症发生率高于预后良好组,差异有统计学意义(均P<0.05)。两组入院第1天的血磷状况比较差异无统计学意义(P>0.05)。经过Logistic回归分析提示入院第3、7天的低磷血症是中重度颅脑损伤患者预后不良的独立危险因素(P<0.05)。ROC曲线分析显示,入院第3、7天的血清磷水平预测患者预后不良的曲线下面积(AUC)分别为0.702和0.811,入院第7天预测的AUC明显高于入院第3天,差异有统计学意义(Z=3.617,P<0.001)。预测的最佳诊断值分别为0.91 mmol/L和0.79 mmol/L。结论:低磷血症在中重度颅脑损伤患者中发生率较高,可能是其预后不良的独立危险因素,临床应当动态监测血磷水平以早期评估患者预后转归情况。Objective:To explore the clinical value of dynamic monitoring of blood phosphorus level in evaluating prognosis of patients with moderate and severe craniocerebral injury.Methods:Clinical data of 122 patients with moderate and severe t craniocerebral injury were collected retrospectively.The prognosis of the patients at 3 months after admission was evaluated by GOS,and the patients were divided into poor prognosis group(42 cases)and good prognosis group(80 cases).The general clinical data and the dynamic changes of blood phosphorus level were collected.Logistic regression was used to analyze the related factors of poor prognosis.ROC curve was used to analyze the predictive value of blood phosphorus level for poor prognosis.Results:The GCS score and serum albumin level in the poor prognosis group were significantly lower than those in the good prognosis group,and the intracranial pressure,serum creatinine and serum C-reactive protein(CRP)in the 24 hours after admission were higher than those in the good prognosis group(all P<0.05).On the 3rd and 7th day after admission,the level of blood phosphorus in the poor prognosis group was significantly lower than that in the good prognosis group,and the incidence of hypophosphatemia was higher than that in the good prognosis group(all P<0.05).There was no significant difference in blood phosphorus status on the first day of admission between the two groups(P>0.05).Logistic regression analysis showed that hypophosphatemia on the 3rd and 7th day after admission was an independent risk factor for poor prognosis of patients with moderate and severe brain injury(P<0.05).ROC curve analysis showed that the area under the curve(AUC)of serum phosphorus level on the 3rd and 7th day of admission to predicte the poor prognosis of patients was 0.702 and 0.811,respectively.The AUC on the 7th day of admission was significantly higher than that on the 3rd day of admission(Z=3.617,P<0.001).The best predictive diagnostic values were 0.91 mmol/L and 0.79 mmol/L,respectively.Conclusion:The in

关 键 词：颅脑损伤 低磷血症 电解质紊乱 血清白蛋白 预后 危险因素 

分 类 号：R651.1[医药卫生—外科学]