重症外科患者机械通气时间与治疗初始血清25-羟维生素D水平

哈佛医学院、哈佛公共卫生学院

马萨诸塞综合医院＝麻省总医院

　　目的：关于血清25-羟维生素D水平与呼吸支持持续时间关系的文献非常有限。本研究旨在探索外科重症患者刚入重症监护病房（ICU）的维生素D水平是否与机械通气持续时间相关。

　　资料与方法：我们对纳入210例外科重症患者的前瞻性队列研究数据进行分析。为了探索进入ICU初始血清25-羟维生素D水平和机械通气持续时间的关系，我们在控制临床相关协变量的情况下，对其进行泊松分析。在该队列分析中，仅仅纳入机械通气≥48h且在中止呼吸支持后存活≥24h的患者。

　　结果：94例患者符合纳入标准。平均（±标准差）血清25-羟维生素D水平为16（±7）ng/mL，机械通气持续时间中位数（四分位间距）为4（2～7）天。通过泊松回归分析对年龄、性别、种族、体重指数、初次手术、急性生理与慢性健康状况评估Ⅱ评分以及入住ICU的季节进行调整后，发现血清25-羟维生素D水平与机械通气持续时间呈负相关（每10ng/mL发生率：0.66；95%可信区间：0.54～0.82）。

　　结论：在我们外科重症患者队列中，进入ICU初始血清25-羟维生素D水平与机械通气持续时间呈负相关。需要进一步随机对照试验评估维生素D补充是否影响外科ICU患者机械通气持续时间。

JPEN J Parenter Enteral Nutr. 2016;40(2):273-8.

Plasma 25-Hydroxyvitamin D Levels at Initiation of Care and Duration of Mechanical Ventilation in Critically Ill Surgical Patients.

Quraishi SA, McCarthy C, Blum L, Cobb JP, Camargo CA Jr.

Harvard Medical School, Boston, MA.

Massachusetts General Hospital, Boston, MA.

Harvard School of Public Health, Boston, MA.

OBJECTIVE: Limited data exist regarding the relationship between plasma 25-hydroxyvitamin D levels and duration of respiratory support. Our goal was to explore whether vitamin D status at the time of intensive care unit (ICU) admission is associated with duration of mechanical ventilation in critically ill surgical patients.

MATERIALS AND METHODS: We analyzed data from a prospective cohort study involving 210 critically ill surgical patients. To explore the relationship between admission plasma 25-hydroxyvitamin D levels and duration of mechanical ventilation, we performed a Poisson regression while controlling for clinically relevant covariates. Only patients who required ≥48 hours of mechanical ventilation and survived ≥24 hours after discontinuation of respiratory support were included in the analytic cohort.

RESULTS: Ninety-four patients met inclusion criteria. Mean (standard deviation) plasma 25-hydroxyvitamin D level was 16 (7) ng/mL and median (interquartile range) duration of mechanical ventilation was 4 (2-7) days. Poisson regression analysis, adjusted for age, sex, race, body mass index, primary surgical service, Acute Physiology and Chronic Health Evaluation II score, and season of ICU admission, demonstrated an inverse association of plasma 25-hydroxyvitamin D levels with duration of mechanical ventilation (incident rate ratio per 10 ng/mL, 0.66; 95% confidence interval, 0.54-0.82).

CONCLUSIONS: In our cohort of critically ill surgical patients, plasma 25-hydroxyvitamin D levels measured on ICU admission were inversely associated with the duration of respiratory support. Randomized controlled trials are needed to assess whether vitamin D supplementation can influence duration of mechanical ventilation in surgical ICU patients.

KEYWORDS: 25(OH)D; critical care; mechanical ventilation; vitamin D

PMID: 25564428

PMCID: PMC4492899

DOI: 10.1177/0148607114566276