中国汶川地震受难者血清电解质紊乱
|
摘要
目的分析汶川地震受难者血清电解质紊乱状况,并探讨其可能的病理机制。方法测定400例受难者入院时血清K、Na、Cl、Ca、Mg和P浓度,进行统计分析。结果检测的6种电解质在各疾病组中,差异均有统计学意义。相关关系显示,各组间多个电解质成分的相关系数呈相反变化,但仅挤压综合征非透析者(r=0.066,P=0.546)与透析者(r=-0.433,P=0.044)间Na-Mg的相关系数转变才有显著性差异。多元统计分析表明,导致受难者发生挤压伤(OR=28.037,P=0.000)和挤压综合征(OR=6.434,P=0.000)风险率最高的电解质成分均是血清K。ROC曲线分析结果显示,诊断为挤压伤特异性(Sp)最高的是K,为98.5%(临界值=5.8 mmol/L),敏感度(Se)最高的是Ca,为81.1%(临界值=1.75 mmol/L);诊断挤压综合征时血清K、Mg和P的Sp相当,分别是86.6%、87.7%和88.7%,Se最高的是Ca,为75.3%。结论自然灾害发生后,受难者的血清电解质紊乱较常见,早期检测受难者血清电解质水平有利于疾病的正确诊断和严重程度判断。
Objective To study the electrolyte disturbances in the sufferers during the Wenchuan earthquake in China,and investigate their possible pathomechanism.Methods Serum concentrations of potassium(K),sodium(Na),chlorine(Cl),calcium(Ca),magnesium(Mg) and inorganic phosphate(P) were determined in four hundred sufferers.Their values were analyzed via statistical method.Results Significant differences of all determined six electrolytes were observed among various groups.Pearson correlation analysis showed that correlative changes among electrolytes were similar in various groups except the correlation coefficients of Na-Mg in dialysis group(r=0.066,P=0.546) and non-dialysis group(r=-0.433,P=0.044).Multivariate logistic analysis revealed the highest risk factor was K+,which led to crush injury(OR=28.037,P=0.000) and crush syndrome(OR= 6.434,P=0.000).The receiver operating characteristic(ROC) curve revealed that K~+ was the most specific(specificity:98.5%;cutoff value:5.8 mmol/L),Ca~(2+) was the most sensitive(sensitivity: 81.1%;cutoff value:1.75 mmol/L) for crush injury diagnosis.The specificity of serum K~+,Mg~(2+) amd P was comparative in diagnosis of crush syndrome.The sensitivity of Ca~(2+) was the highest,accounting for 75.3%.Conclusion Electrolyte disturbances of suffers occur during a natural disaster; serum electrolyte measurement contributes to correct diagnosis and severity assessment.
Objective To study the electrolyte disturbances in the sufferers during the Wenchuan earthquake in China,and investigate their possible pathomechanism.Methods Serum concentrations of potassium(K),sodium(Na),chlorine(Cl),calcium(Ca),magnesium(Mg) and inorganic phosphate(P) were determined in four hundred sufferers.Their values were analyzed via statistical method.Results Significant differences of all determined six electrolytes were observed among various groups.Pearson correlation analysis showed that correlative changes among electrolytes were similar in various groups except the correlation coefficients of Na-Mg in dialysis group(r=0.066,P=0.546) and non-dialysis group(r=-0.433,P=0.044).Multivariate logistic analysis revealed the highest risk factor was K+,which led to crush injury(OR=28.037,P=0.000) and crush syndrome(OR= 6.434,P=0.000).The receiver operating characteristic(ROC) curve revealed that K~+ was the most specific(specificity:98.5%;cutoff value:5.8 mmol/L),Ca~(2+) was the most sensitive(sensitivity: 81.1%;cutoff value:1.75 mmol/L) for crush injury diagnosis.The specificity of serum K~+,Mg~(2+) amd P was comparative in diagnosis of crush syndrome.The sensitivity of Ca~(2+) was the highest,accounting for 75.3%.Conclusion Electrolyte disturbances of suffers occur during a natural disaster; serum electrolyte measurement contributes to correct diagnosis and severity assessment.
引文
[1]Guanl AI,Celiker H,Dogukan A,et al.Early and vigorous fluid resuscitation prevents acute renal failure in the crush victims of catastrophic earthquakes[J].J Am Soc Nephrol,2004,15(7): 1862-1867.
[2]Sever MS,Erek E,Vanholder R,et al.Serum potassium in the crush syndrome victims of the Marmara disaster[J].Clin Nephrol, 2003,59(5):326-333.
[3]Kishore B,Thurlow V,Kessel B.Hypokalaemic rhabdomyolysis [J].Ann Clin Biochem,2007,44(3):308-311.
[4]Ting JY.Rhabdomyolysis and polydipsic hyponatraemia[J]. Emerg Med J,2001,18(6):520.
[5]Shiber JR,Mattu A.Serum phosphate abnormalities in the emergency department[J].J Emerg Med,2002,23(4):395-400.
[6]Liamis G,Mitrogianni Z,Liberopoulos EN,et al.Electrolyte disturbances in patients with hyponatremia[J].Intern Med,2007, 46(11):685-690.
[2]Sever MS,Erek E,Vanholder R,et al.Serum potassium in the crush syndrome victims of the Marmara disaster[J].Clin Nephrol, 2003,59(5):326-333.
[3]Kishore B,Thurlow V,Kessel B.Hypokalaemic rhabdomyolysis [J].Ann Clin Biochem,2007,44(3):308-311.
[4]Ting JY.Rhabdomyolysis and polydipsic hyponatraemia[J]. Emerg Med J,2001,18(6):520.
[5]Shiber JR,Mattu A.Serum phosphate abnormalities in the emergency department[J].J Emerg Med,2002,23(4):395-400.
[6]Liamis G,Mitrogianni Z,Liberopoulos EN,et al.Electrolyte disturbances in patients with hyponatremia[J].Intern Med,2007, 46(11):685-690.
版权所有：© 2023 中国地质图书馆 中国地质调查局地学文献中心