动态血磷水平监测在体外动静脉膜肺氧合患者预后评估中的应用价值  

Clincal value of dynamic monitoring of blood phosphorus level in evaluating prognosis of patients treated with VA-extracorporeal membrane oxygenation

作　　者：陈晨 季荔 杨洋 张刚 李伟 陈旭锋 Chen Chen;Ji Li;Yang Yang;Zhang Gang;Li Wei;Chen Xufeng(Department of Emergency,the First Affiliated Hospital of Nanjing Medical University,Jiangsu Provincial People's Hospital,Nanjing 210000,Jiangsu,China)

机构地区：[1]南京医科大学第一附属医院(江苏省人民医院)急诊医学科,江苏南京210000

出　　处：《中国医学前沿杂志（电子版）》2024年第12期22-26,共5页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

基　　金：国家自然科学基金资助项目(82072159)。

摘　　要：目的探究动态血磷水平监测在评估动静脉体外膜肺氧合(veno-arterial extracorporeal membrane oxygenation,VA-ECMO)患者预后转归中的临床价值。方法回顾性分析2020年5月至2023年9月于江苏省人民医院急诊重症监护室接受VA-ECMO治疗的118例患者的临床资料,根据治疗28 d预后将患者分为生存组和死亡组。监测人口统计学资料、临床资料,以及VA-ECMO上机当天、第1天,第2天及第3天血磷水平,分析影响VA-ECMO患者生存危险因素,使用R软件中的surv_cutpoint函数获得血磷的最佳截断点、优化Kaplan-Meier生存曲线,分析血磷对患者生存率的预测价值。结果118例患者中,生存组68例(57.63%),死亡组50例(42.37%)。与死亡组相比,生存组ECMO转机时间、ICU住院时间更长,差异有统计学意义(P<0.05);死亡组入院第1天的血磷水平及其与基线值百分比显著低于生存组(分别为0.81 mmol/L比0.93 mmol/L,0.30%比0.15%,均P<0.05)。logistic多因素回归分析显示上机当天及上机后第1天低磷血症是VA-ECMO患者预后不良的独立危险因素(P=0.042,0.004);使用R软件中的surv_cutpoint函数取得血磷的最佳截断点为0.84 mmol/L,据此将患者分为低磷组(≤0.84 mmol/L)及非低磷组(>0.84 mmol/L),非低磷组的28 d生存率显著高于低磷组(P=0.0076)。结论血磷水平尤其是ECMO上机后第1天血磷水平可以作为影响VA-EC-MO患者预后的独立危险因素,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 levels in evaluating the prognosis of patients treated with VA-extracorporeal membrane oxygenation(VA-ECMO).Methods The clinical data of 118 patients who received VA-ECMO treatment in the emergency care ward of Jiangsu People's Hospital from May 2020 to September 2023 were retrospectively collected,and the patients were divided into a survival group and a death group according to the prognosis after 28 days of treatment.Monitoring demographic data,clinical data,as well as serum phosphate levels and changes on the day of VA-ECMO)initiation,and on the 1st,2nd,and 3rd days,to analyze the risk factors of survival in VA-ECMO patients.The optimal cut-off value for the risk score based on serum phosphate was determined using the'surv_cutpoint'function in R software.This function optimized the significance of the split between Kaplan-Meier survival curves and analyzed the predictive value of serum phosphate for short-term survival rates in patients.Results Among 118 patients,there were 68 cases in the survival group(57.63%)and 50 cases in the death group(42.37%).Compared with the death group,the survival group had a longer ECMO conversion time and extended ICU stay,showing statistically significant differences(P<0.05).The blood phosphorus levels on the first day of admission and the percentage compared to baseline values in the death group were significantly lower than those in the survival group(0.81 mmol/L vs.0.93 mmol/L,0.30%vs.0.15%,respectively,P<0.05).Logistic regression analysis showed that hypophosphatemia on the day of ECMO initiation and on the first day after ECMO initiation was an independent risk factor for poor prognosis in VA-ECMO patients(P=0.042,0.004).The surv_cutpoint function in the R software determined the optimal cutoff value for blood phosphorus to be 0.84 mmol/L.Based on this,patients were divided into a low phosphorus group(≤0.84 mmol/L)and a non-low phosphorus group(>0.84 mmol/L).The 28-day survival rate in the

关 键 词：体外膜肺氧合 低磷血症 预后 危险因素 

分 类 号：R459.7[医药卫生—急诊医学]