脓毒症患儿血清钙、磷和钙磷乘积的变化及意义  

Change and significance of serum calcium,phosphorus and calcium-phosphorus product in children with sepsis

作　　者：朱玲[1] 樊丹 吴水燕[1] 柏振江[1] 周利兵[1] ZHU Ling;FAN Dan;WU Shuiyan;BAI Zhenjiang;ZHOU Libing(Department of Intensive Care Medicine,Affiliated Children's Hospital,Soochow University,Suzhou 215000,CHINA)

机构地区：[1]苏州大学附属儿童医院重症医学科,江苏215000 [2]芜湖市第一人民医院儿科,安徽

出　　处：《江苏医药》2025年第2期113-117,共5页Jiangsu Medical Journal

摘　　要：目的探讨脓毒症患儿血清钙、磷和钙磷乘积的变化及其意义。方法155例脓毒症患儿根据血清磷水平分为高磷血症组(56例)、正常血磷组(69例)和低磷血症组(30例);根据血清钙水平分为高钙血症组(10例)、正常血钙组(33例)和低钙血症组(112例);根据钙磷乘积分为高钙磷乘积组(51例)、正常钙磷乘积组(28例)和低钙磷乘积组(76例)。比较不同血磷组、不同血钙组和不同钙磷乘积组患儿的临床特征,分析不同血清磷、血清钙和钙磷乘积与实验室指标的相关性。结果高磷血症组抽搐、休克、死亡、呼吸衰竭、急性肾损伤、肝损害和多器官功能障碍综合征(MODS)患儿比例均高于正常血磷组(P<0.05)。低钙血症组休克、死亡、呼吸衰竭、神经系统障碍和MODS患儿比例均高于正常血钙组(P<0.05)。155例脓毒症患儿中,高磷血症合并低钙血症患儿的死亡比例最高。脓毒症患儿血清磷水平与WBC、CRP、ALT、肌酸激酶同工酶(CK-MB)、乳酸和D-D呈正相关,与白蛋白呈负相关(P<0.05或P<0.01);血清钙水平与白蛋白、纤维蛋白原呈正相关,与TBil、尿素氮、肌酐、CK-MB、乳酸呈负相关(P<0.05或P<0.01);钙磷乘积与WBC、CRP、Hb、Plt、CK-MB和乳酸呈正相关,与白蛋白呈负相关(P<0.05或P<0.01)。结论低钙血症和高磷血症是儿童脓毒症中经常发生的一种病理状态,伴随较高的器官功能损害和病死率。同时发生低钙血症及高磷血症的患儿更易死亡。Objective To investigate the change and its clinical significance of serum calcium,phosphorus and calcium-phosphorus product in the children with sepsis.Methods According to serum phosphorus level,155 children with sepsis were divided into hyperphosphatemia group(56cases),normal serum phosphorus group(69cases)and hypophosphatemia group(30cases).According to serum calcium level,they were divided into hypercalcemia group(10cases),normal serum calcium group(33cases)and hypocalcemia group(112cases).According to calcium-phosphorus product,they were divided into high calcium-phosphorus product group(51cases),normal calcium-phosphorus product group(28cases)and low calcium-phosphorus product group(76cases).The clinical features of the children in different serum phosphorus groups,different serum calcium groups and different calcium-phosphorus product groups were compared.The correlation of different serum phosphorus,serum calcium and calcium-phosphorus product with laboratory indicators was analyzed.Results The proportions of the children with convulsion,shock,death,respiratory failure,acute kidney injury and multiple organ dysfunction syndrome(MODS)in hyperphosphatemia group were higher than those in normal serum phosphorus group(P<0.05).The proportions of the children with shock,death,respiratory failure,neurological disorders and MODS in hypocalcemia group were higher than those in normal serum calcium group(P<0.05).Among 155 children with sepsis,those with concurrent hypocalcemia and hyperphosphatemia had the highest mortality.In children with sepsis,serum phosphorus level was positively correlated with WBC,CRP,ALT,creatine kinase MB(CK-MB),lactate and D-D,and negatively correlated with albumin(P<0.05 or P<0.01),serum calcium level was positively correlated with albumin and fibrinogen,and negatively correlated with TBil,urea nitrogen,creatinine,CK-MB and lactate(P<0.05 or P<0.01),and the product of calcium and phosphorus was positively correlated with WBC,CRP,Hb,Plt,CK-MB and lactate,and negatively correlated with al

关 键 词：脓毒症 低钙血症 高磷血症 儿童 

分 类 号：R631[医药卫生—外科学]