脓毒症合并低钙血症患者预后的影响因素  

Prognostic factors in patients with sepsis complicated with hypocalcemia

作　　者：张艳 宋芹 王元新[1] 张永磊 Zhang Yan;Song Qin;Wang Yuanxin;Zhang Yonglei(Emergency Department,Yantaishan Hospital,Yantai Shandong 264003,China)

机构地区：[1]山东省烟台市烟台山医院急诊科,山东烟台264003

出　　处：《保健医学研究与实践》2023年第7期31-35,共5页Health Medicine Research and Practice

基　　金：山东省自然科学基金项目(ZR2020QH115);烟台市科技计划项目(2021YD053);2022年度山东省医学会专项资金项目(YXH2022ZX06305)。

摘　　要：目的探讨离子钙(iCa)水平与脓毒症患者心功能的关系及脓毒症合并低钙血症患者预后的影响因素。方法选取2020年6月—2021年12月烟台市烟台山医院收治的157例脓毒症患者的临床资料进行回顾性队列研究,根据iCa水平将患者分为iCa正常组(78例)和低钙血症组(79例)。根据预后情况将低钙血症患者分为预后良好组(27例)和预后不良组(52例)。比较iCa正常组和低钙血症组患者的生化指标、心电图检查结果(心肌酶谱、肌钙蛋白T、脑钠钛、乳酸、肝肾功能、心电图QT间期)及急性生理学和慢性健康状况评价Ⅱ表(APACHEⅡ)评分等指标,采用多元Logistic回归分析脓毒症合并低钙血症患者预后的影响因素。结果低钙血症组患者的心肌酶谱指标、肌钙蛋白T、脑钠肽、乳酸及肝肾功能指标水平均高于iCa正常组,心电图QT间期长于iCa正常组,差异均有统计学意义(P<0.05)。预后不良的脓毒症合并低钙血症患者血清总钙、血清游离钙、APACHEⅡ评分、肌酸激酶、肌酸激酶同工酶、乳酸脱氢酶水平均高于预后良好患者,差异均有统计学意义(P<0.05)。多元Logistic回归分析结果显示,血清总钙≤1.88 mmol/L、血清游离钙≤1.09 mmol/L、APACHEⅡ评分>29分、肌酸激酶>196.75 U/L、肌酸激酶同工酶>59.82 U/L、乳酸脱氢酶>452.96 U/L是脓毒症合并低钙血症患者预后不良的危险因素(P<0.05)。结论脓毒症患者的iCa水平与心功能关系密切,血清总钙、血清游离钙、APACHEⅡ评分、肌酸激酶、肌酸激酶同工酶、乳酸脱氢酶水平是脓毒症合并低钙血症患者预后不良的影响因素,临床可以根据这些指标对脓毒症合并低钙血症患者的心功能及预后进行评估。Objective This study aimed to investigate the relationship between ionized calcium(iCa)level and cardiac function in sepsis patients and influencing factors in the prognosis of septic patients with hypocalcemia.Methods A retrospective cohort study was conducted on the clinical data of 157 patients with sepsis admitted to Yantaishan Hospital from June 2020 to December 2021.The patients were allocated to the normal iCa group(n=78)and the hypocalcemia group(n=79)in agreement with iCa level.According to the prognosis,patients with hypocalcemia were assigned to the good prognosis group(n=27)and the poor prognosis group(n=52).Biochemical parameters,electrocardiographic findings(myocardial enzymes,troponin T,BNP,lactate,liver and kidney function,electrocardiographic QT interval),and Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)scores were compared between patients with normal iCa and hypocalcemia.Multiple logistic regression was used to analyze the influencing factors in the prognosis of patients with hypocalcemic sepsis.Results The levels of myocardial enzyme spectrum,troponin T,BNP,lactate and liver and kidney function in the hypocalcemia group were higher than those in the iCa normal group,and the QT interval in ECG was longer than that in the iCa normal group,with statistical significance(P<0.05).Serum total calcium,serum-free calcium,APACHEⅡscore,creatine kinase,creatine kinase isoenzyme,and lactate dehydrogenase levels were significantly higher in hypocalcemic sepsis patients with poor prognosis than in patients with good prognosis(P<0.05).The results of multiple logistic regression analysis showed that serum total calcium(≤1.88 mmol/L),serum-free calcium(≤1.09 mmol/L),APACHEⅡscore(>29 points),creatine kinase(>196.75 U/L),creatine kinase isoenzyme(>59.82 U/L),and lactate dehydrogenase(>452.96 U/L)were risk factors for the poor prognosis of hypocalcemic sepsis patients(P<0.05).Conclusion The level of iCa is closely related to cardiac function in patients with sepsis.The levels of serum total

关 键 词：离子钙 脓毒症 心功能 疾病预后 危险因素 

分 类 号：R631.2[医药卫生—外科学]