补磷治疗对慢性阻塞性肺疾病脱离机械通气的影响

摘要

目的 探讨静脉补磷治疗慢性阻塞性肺疾病(COPD)行机械通气患者对脱离呼吸机以及预后的影响.方法 将64例COPD机械通气患者随机分为两组,对照组30例,予常规治疗及机械通气,低磷血症未得到纠正.治疗组34例,在常规治疗,机械通气的基础上静脉滴注复合磷酸氢钾,并监测血磷情况,当血磷升至0.65 mmol/L,停止肠道外补磷,使血磷维持在正常水平.结果 治疗组脱机成功率高于对照组(47.1%比23.3%,P <0.05);治疗组多脏器功能障碍(MODS)发生率低于对照组(32.4%比60.0%,P <0.05);治疗组病死率低于对照组(29.4%比56.7%,P ＜0.05);治疗组脱机时间短于对照组[(5.2±1.8)d比(9.2±1.6)d,P <0.01].结论 COPD机械通气患者合并低磷血症经积极纠正低磷血症对提高脱机成功率,降低MODS发生率有积极意义,值得临床重视.%Objective To explore the effects of intravenous phosphate replacement therapy to the weaning off mechanical ventilators and the prognosis of mechanical - ventilated chronic obstructive pulmonary disease (COPD) patients. Methods 64 mechanical -ventilated COPD patients were divided into two treatment groups perspectively, in the control group, 30 cases were treated by routine therapies and mechanical ventilations, without correcting hypophosphatemia. In the therapeutic group, 34 cases were managed by intravenous infusions of potassium hydrogen phosphate, in addition to routine therapies and mechanical ventilations, and blood levels of phosphate were monitored. The parental phosphate supplements were discontinued when blood level of phosphate rose to 0. 65 mmol/L and normal blood phosphate levels were maintained. Results Comparing with control group, the successful rate of weaning off mechanical ventilators was higher (47. 1％ to23.3 ％, P ＜ 0. 05 ), the weaning time was shorter[ (5.2 ± 1.8 )d to (9.2 4± 1.6)d, P ＜ 0. 01 ], the incidence of multiple organ dysfunction syndrome (MODS) Was lower ( 32.4％ to 60.0％, P ＜ 0. 05 ), and the mortality rate was lower ( 29. 4％ to 56. 7 ％, P ＜ 0. 05 ) in therapeutic group. Conclusions Aggressive phosphate repletion for mechanical-ventilated COPD patients with hypophosphatemia shows positive significance for enhancing the successful rate of weaning off mechanieal ventilators and decreasing the incidence of MODS. It should be emphasized clinically.