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目的:探讨中重度颅脑损伤患者早期血磷水平与近期预后的相关性。方法:将97例中重度颅脑损伤患者按照入院后24 h内的血磷水平分为低磷血症组(n=23例,血磷<0.80 mmol/L)和正常血磷组(n=74例,血磷≥0.80 mmol/L);记录患者入院后28 d的预后情况,按照是否死亡分为死亡组及存活组,比较两组相关指标的差异。用Logistic回归方程分析血磷水平与患者死亡的关系,应用ROC曲线评估血磷水平预测患者死亡的临床价值。结果:与血磷正常组比较,低磷血症组患者发病至入院时间较长、入院时血压及GCS评分较低、入院APACHEⅡ评分较高,死亡率偏高(P<0.05);死亡组患者入院GCS评分低于存活组,而APACHEⅡ评分高于存活组(P<0.05);血磷水平及低磷血症的发生率高于存活组(P<0.05),多因素Logistic回归方程分析提示:血磷降低是中重度颅脑损伤患者入院28d后死亡的独立危险因素(P<0.05)。血磷水平(≤0.68 mmol/L)预测患者死亡的曲线下面积(ROCAUC)分别为:0.889;灵敏度和特异度分别为:83.9%;77.6%。最佳诊断截点为0.68 mmol/L。结论:血磷水平降低可能是中重度颅脑损伤患者近期死亡的独立危险因素,早期检测血磷水平对评估患者近期预后具有一定的临床意义。
Objective: To investigate the correlation between early serum phosphorus level and the prognosis in moderate and severe traumatic brain injury. Methods: 97 patients with severe craniocerebral injury were divided into hypophosphatemia group (n = 23, serum phosphorus <0.80 mmol / L) and normal phosphorus group (n = 74 cases, serum phosphorus≥0.80 mmol / L). The prognosis of patients at 28 days after admission was recorded and divided into death group and survival group according to whether they died or not. The differences between the two groups were compared. Logistic regression equation was used to analyze the relationship between the level of serum phosphorus and the death of patients. The ROC curve was used to evaluate the clinical value of serum phosphorus level in predicting the death of patients. Results: Compared with the normal group, the patients with hypophosphatemia showed longer hospitalization time, lower admission pressure and GCS scores, higher admission APACHEⅡ scores and higher mortality (P <0.05). Patients in the death group The admission GCS score was lower than the survival group, but the APACHEⅡ score was higher than that of the survival group (P <0.05). The incidence of serum phosphorus and hypophosphatemia was higher than that of the survival group (P <0.05). Multivariate Logistic regression analysis indicated: The decrease of serum phosphorus was an independent risk factor for death in medium and severe craniocerebral injury patients 28 days after admission (P <0.05). The area under the curve (ROCAUC) predicted by the serum phosphorus level (≤0.68 mmol / L) was 0.889; the sensitivity and specificity were 83.9% and 77.6% respectively. The best diagnostic cutoff is 0.68 mmol / L. Conclusion: The decreased serum phosphorus level may be an independent risk factor for recent death in patients with moderate and severe traumatic brain injury. The early detection of serum phosphorus level has some clinical significance in evaluating the short-term prognosis of patients.