低磷血症对重症急性胰腺炎患者预后的影响  

Influence of hypophosphatemia on the prognosis of patients with severe acute pancreatitis

作　　者：张频捷[1] 曹利军[1] 鹿中华[1] 付路 孙昀[1] Zhang Pinjie;Cao Lijun;Lu Zhonghua;Fu Lu;Sun Yun(First Department of Critical Care Medicine,The Second Affiliated Hospital of Anhui Medical University)

机构地区：[1]安徽医科大学第二附属医院重症医学一科,合肥230601

出　　处：《重庆医科大学学报》2024年第11期1429-1433,共5页Journal of Chongqing Medical University

基　　金：安徽医科大学第二附属医院临床研究培育计划资助项目(编号:2020LCZD08)。

摘　　要：目的:探讨低磷血症对重症急性胰腺炎(severe acute pancreatitis,SAP)患者预后的影响。方法:回顾性分析2013年1月至2022年12月安徽医科大学第二附属医院重症医学科(intensive care unit,ICU)收治符合入组标准的179例SAP患者的临床资料。根据患者入院时测定的血磷水平分为低磷血症组(血磷<0.80 mmol/L)和非低磷血症组(血磷≥0.80 mmol/L)。记录患者入院时的一般情况、ICU住院时间、总住院时间、机械通气情况、临床预后和并发症等临床资料。采用多因素logistic回归分析评估低磷血症与SAP患者继发腹腔感染和预后的关系。绘制受试者工作特征(receiver operator characteristic,ROC)曲线,计算ROC曲线下面积(area under the curve,AUC)及其95%可信区间(95%confidence interval,95%CI),评价多元回归模型对SAP患者继发腹腔感染和院内死亡的预测价值。结果:与非低磷血症组相比,低磷血症组需要机械通气的比例、腹腔感染的发生率明显升高,总住院时间明显延长[机械通气比例:60.3%(47/78)比44.6%(45/101),腹腔感染的发生率:43.6%(34/78)比22.8%(23/101),总住院时间(d):26.5(16.0,34.5)比20.0(14.0,30.0),均P<0.05]。2组患者在腹腔出血、机械通气时间、ICU住院时间和住院期间死亡率方面比较差异均无统计学意义(均P>0.05)。多因素logistic回归分析显示,低磷血症是SAP患者继发腹腔感染和院内死亡的独立危险因素之一,OR值分别为2.985(95%CI=1.434~6.213,P<0.05)和2.878(95%CI=1.069~7.747,P<0.05)。ROC曲线分析显示,多元回归模型预测SAP患者继发腹腔感染和院内死亡的AUC分别为0.797(95%CI=0.729~0.886)和0.879(95%CI=0.816~0.942),均P<0.001。结论:低磷血症的SAP患者机械通气和继发腹腔感染的比例更高,总住院时间更长。低磷血症是SAP患者继发腹腔感染和院内死亡的独立危险因素之一。Objective:To investigate the influence of hypophosphatemia on the prognosis of patients with severe acute pancreatitis(SAP).Methods:A retrospective analysis was performed for the clinical data of 179 SAP patients who were admitted to the intensive care unit(ICU)of The Second Affiliated Hospital of Anhui Medical University from January 2013 to December 2022 and met the crite-ria for enrollment,and according to the level of serum phosphate measured on admission,they were divided into hypophosphatemia group(serum phosphorus<0.80 mmol/L)and non-hypophosphatemia group(serum phosphorus≥0.80 mmol/L).Related clinical data were recorded,such as general condition on admission,length of ICU stay,length of hospital stay,mechanical ventilation,clinical prog-nosis,and complications.The multivariate logistic regression analysis was used to investigate the association of hypophosphatemia with secondary intra-abdominal infection and prognosis in SAP patients.The receiver operator characteristic(ROC)curve was plotted,and the area under the ROC curve(AUC)and its 95%confidence interval(CI)were calculated to evaluate the value of the multivariate re-gression model in predicting secondary intra-abdominal infection and in-hospital death of SAP patients.Results:Compared with the non-hypophosphatemia group,the hypophosphatemia group had a significantly higher proportion of patients requiring mechanical venti-lation[60.3%(47/78)vs.44.6%(45/101),P<0.05],a significant increase in the incidence rate of intra-abdominal infection[43.6%(34/78)vs.22.8%(23/101),P<0.05],and a significantly longer length of hospital stay[26.5(16.0,34.5)days vs.20.0(14.0,30.0)days,P<0.05].There were no significant differences between the two groups in the incidence rate of intra-abdominal hemorrhage,du-ration of mechanical ventilation,length of ICU stay,and in-hospital mortality rate(all P>0.05).The multivariate logistic regression analysis showed that hypophosphatemia was an independent risk factor for intra-abdominal infection(odds ratio[OR]=2.985,95%CI=1.434-6.

关 键 词：低磷血症 胰腺炎 腹腔感染 病死率 

分 类 号：R576[医药卫生—消化系统]