ICU病房里关于高磷血症和低磷血症的分析
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Analysis of Hypo- and Hyperphosphatemia in an Intensive Care Unit Cohort
背景与目的
血磷酸盐水平的变化常常被忽视，血磷水平易受其波动的影响。本研究的目的是评估磷酸盐水平的变化是否与更高的180天总死亡率或发病率有关。
方 法
对2006-2014年在瑞典SKåNE大学医院成人ICU病房的接受治疗的血磷酸值在19467的4656例患者进行回顾性分析，分为对照组和3个研究组：低磷血症、高磷血症、混合组：低/高磷血症。性别、年龄、最大器官序贯器官衰竭评分疾病严重程度，肾序贯器官衰竭评分，最低钙值以及诊断被纳入Cox风险模型混杂因素，进入ICU后180天内的死亡时间作为结局指标。
结 果
与正常对照组相比，高磷血症组与高死亡危险相关，危害比为1.2（98.3%置信区间为1.0~1.5，P = 0.0089）。低磷血症或混合组和对照组相比死亡率没有不同。和所有其他组相比，混合组的上呼吸机时间和ICU总停留时间较长。
结 论
ICU患者磷酸盐的波动很常见，而这与更高的发病率和死亡率相关。许多潜在的病理生理机制可能在这其中发挥了作用。快速变化的血磷酸盐水平或孤立的低或高磷血症应立即纠正。
原始文献摘要
Broman M1, Wilsson AMJ,et al; Analysis of Hypo- and Hyperphosphatemia in an Intensive Care Unit Cohort. ;Anesth Analg. 2017 Jun;124(6):1897-1905. doi:10.1213/ANE.0000000000002077.
Background:Blood phosphate levels are vulnerable to fluctuations and changes in phosphate levels are often neglected. The aim of this study was to evaluate whether deviations in phosphate levels correlate to higher 180-day overall mortality or morbidity.
METHODS:Four thousand six hundred fifty-six patients with 19,467 phosphate values treated at the adult intensive care unit at Skåne University Hospital, Lund, Sweden during 2006-2014 were retrospectively divided into a control group and 3 study groups: hypophosphatemia, hyperphosphatemia, and a mixed group showing both hypo/hyperphosphatemia. Sex, age, disease severity represented by maximal organ system Sequential Organ Failure Assessment score, renal Sequential Organ Failure Assessment score, lowest ionized calcium value, and diagnoses classes were included in a Cox hazard model to adjust for confounding factors, with time to death in the first 180 days from the intensive care unit (ICU) admission as outcome.
RESULTS:When compared to normophosphatemic controls, the hyperphosphatemic study group was associated with higher risk of death with a hazard ratio of 1.2 (98.3% confidence interval 1.0-1.5, P = .0089). Mortality in the hypophosphatemic or mixed study group did not differ from controls. The mixed group showed markedly longer ventilator times and ICU stays compared to all other groups.
CONCLUSIONS:Phosphate alterations in ICU patients are common and associated with worse morbidity and mortality. Many underlying pathophysiologic mechanisms may play a role. A rapidly changing phosphate level or isolated hypo or hyperphosphatemia should be urgently corrected. (Anesth Analg 2017; 124(6):1897-1905)
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