标题：初始血清钙离子浓度对ICU严重创伤患者病情及预后的预测价值

      作者：唐洪波 1，马兴龙 1，王茜 2，唐洪焱 1，谢鹏 1，陈微微 1，王兆 1，王远方 1，蒲盛蓝 1，温建立 1    1.遵义医科大学第三附属医院 遵义市第一人民医院，贵州 遵义 563002；2.遵义医科大学第一附属医院，贵州 遵义 563000

      卷次： 2020年31卷6期

      【摘要】 目的 探讨初始低钙血症水平对 ICU严重创伤患者预后的预测价值。方法 选取 2015年 1月至2018年 12月遵义市第一人民医院 ICU创伤患者 117例，根据初始离子钙浓度(iCa)分组，其中钙离子正常组 18例(iCa≥1.12 mmol/L)、低钙血症组74例(0.90≤iCa<1.12 mmol/L)、严重低钙血症组25例(iCa<0.90 mmol/L)。比较各组患者创伤严重度评分(ISS评分)、APACHEⅡ评分、是否需大量输血方案、ICU住院时间和28 d死亡率的差异。结果 三组患者的性别、年龄及创伤类型(钝挫伤、贯穿伤及其他)比较差异均无统计学意义(P>0.05)；低钙血症组与钙离子正常组的 ISS评分[(34.9±8.7)分 vs (27.3±5.1)分]、APACHEⅡ评分[(19.2±6.7 )分 vs (15.6±3.4)分]、需要大量输血方案比例(24% vs 0)、ICU住院时间[(9.1±3.1) d vs (3.6±1.3) d]及28 d死亡率(20% vs 0)比较，低钙血症组明显高于钙离子正常组，差异均有统计学意义(P<0.05)；严重低钙血症组与低钙血症组患者的 ISS评分[(40.2±8.2 )分 vs (34.9±8.7)分]、APACHEⅡ评分[(23.8±8.0 )分 vs (19.2±6.7)分]、需要大量输血方案比例(48% vs 24%)及28 d死亡率(44% vs 20%)比较，严重低钙血症组明显高于低钙血症组，差异均具有统计学意义(P<0.05)。结论 创伤患者常合并低钙血症，钙离子浓度越低，病情越严重、死亡率越高；初始离子钙浓度水平可作为早期预测创伤患者病情及预后的参考指标。
      【关键词】 创伤；低钙血症；钙离子浓度；预测；预后
      【中图分类号】 R641 【文献标识码】 A 【文章编号】 1003—6350（2020）06—0738—03

Value of initial serum ionized calcium concentration in evaluating disease condition and prognosis of severetrauma in ICU.
TANG Hong-bo 1, Ma Xing-long 1, WANG Qian 2, TANG Hong-yan 1, XIE Peng 1, CHEN Wei-wei 1, WANGZhao 1, WANG Yuan-fang 1, PU Sheng-lan 1, WEN Jian-li 1. 1. the Third Affiliated Hospital of Zunyi Medical University,the First People's Hospital of Zunyi, Zunyi 563002, Guizhou, CHINA; 2. Zunyi Medical University Affiliated Hospital, Zunyi563000, Guizhou, CHINA
【Abstract】 Objective To investigate the value of initial serum ionized calcium concentration in evaluatingprognosis of severe trauma in ICU. Methods A total of 117 patients with severe trauma, who admitted to ICU of ZunyiFirst People's Hospital from January 2015 to December 2018, were selected as the research subjects. According to initialserum ionized calcium concentration, the patients were divided into three groups, including normal calcium ions group(iCa≥1.12 mmol/L, n=18), hypocalcemia group (0.90 mmol/L≤iCa<1.12 mmol/L, n=20) and severe hypocalcemiagroup (iCa<0.90 mmol/L, n=25). The differences of the trauma Injury Severity Score (ISS), Acute Physiology and Chron-ic Health Evaluation (APACHE) Ⅱ, whether was given a large number blood transfusion, duration of hospitalization ofICU, and the mortality rate of 28 days were compared among the three groups. Results There was no significant differ-ence in sex, age and type of trauma (contusion, penetration injury and others) among the three groups (all P>0.05). ISSscore, APACHE Ⅱ score, the percent of patients given a large number blood transfusion, duration of hospitalization ofICU, mortality rate of 28 days in the hypocalcemia group were 34.9±8.7, 19.2±6.7, 24%, (9.1±3.1) d, 20%, respectively,which were significantly higher than corresponding 27.3±5.1, 15.6±3.4, 0, (3.6±1.3) d, 0 in normal calcium ions group(all P<0.05); the ISS score, APACHEⅡ score, the percent of patients given a large number blood transfusion, mortalityrate of 28 days in the hypocalcemia group were significantly lower than corresponding 40.2±8.2, 23.8±8.0, 48%, 44% inthe severe hypocalcemia group (all P<0.05). Conclusion Hypocalcemia is often complicated with trauma, and lowerserum ionized calcium concentration is associated with more serious disease condition and higher mortality, and the levelof initial ionized calcium concentration can be used as a reference index for early evaluating the disease condition andprognosis of severe trauma.
      【Key words】 Trauma; Hypocalcemia; Ionized calcium concentration; Prediction; Prognosis