Dickerson R N, Gervasio J M, Sherman J J, Kudsk K A, Hickerson W L, Brown R O
Department of Clinical Pharmacy, The University of Tennessee Health Science Center, Memphis 38163, USA.
JPEN J Parenter Enteral Nutr. 2001 May-Jun;25(3):152-9. doi: 10.1177/0148607101025003152.
To compare phosphorus intake and renal phosphorus regulation between thermally injured patients and multiple trauma patients, 40 consecutive critically ill patients, 20 with thermal injury and 20 with multiple trauma, who required enteral tube feeding were evaluated. Phosphorus intakes were recorded for 14 days from the initiation of tube feeding which was started 1 to 3 days postinjury. Serum for determination of phosphorus concentrations was collected at days 1, 3, 7, and 14 of the study period. A 24-hour urine collection was obtained during the first and second weeks of nutrition support for urinary phosphorus excretion, fractional excretion of phosphorus, renal threshold phosphate concentration, and phosphorus clearance. Average total daily phosphorus intake during the 14-day study for thermally injured patients and multiple trauma patients was 0.99+/-0.26 mmol/kg/d vs 0.58+/-0.21 mmol/kg/d, respectively, p < .001. Serum phosphorus concentration on the third day of observation was significantly lower in the thermally injured group than those with multiple trauma (1.9+/-0.8 mg/dL vs 3.0+/-0.8 mg/dL, p < or = .01). A trend toward hypophosphatemia in the thermally injured group persisted by the seventh day of feeding (2.7+/-1.2 mg/dL vs 3.3+/-0.6 mg/dL, p < or = .04). Differences in urinary phosphorus excretion was not statistically significant between the thermally injured and multiple trauma groups (271+/-213 mg/d vs 171+/-181 mg/d for week 1, and 320+/-289 mg/d vs 258+/-184 mg/d for week 2, respectively). Urinary phosphorus clearance, fractional excretion of phosphorus, or renal threshold phosphate concentrations were also not significantly different between thermally injured and multiple trauma patients. During nutrition support, serum phosphorus concentrations are lower in thermally injured patients compared with multiple trauma patients despite receiving a significantly greater intake of phosphorus. Renal phosphorus regulation does not significantly contribute to the profound hypophosphatemia observed in thermally injured patients when compared with multiple trauma patients during nutrition support.
为比较热烧伤患者和多发伤患者的磷摄入量及肾脏对磷的调节情况，对40例连续的危重症患者进行了评估，其中20例为热烧伤患者，20例为多发伤患者，均需要肠内管饲。从伤后1至3天开始管饲，记录管饲开始后14天的磷摄入量。在研究期的第1、3、7和14天采集血清用于测定磷浓度。在营养支持的第一周和第二周进行24小时尿液收集，以检测尿磷排泄、磷排泄分数、肾阈磷浓度和磷清除率。热烧伤患者和多发伤患者在14天研究期间的平均每日总磷摄入量分别为0.99±0.26 mmol/kg/d和0.58±0.21 mmol/kg/d，p<0.001。热烧伤组观察第3天时的血清磷浓度显著低于多发伤组（1.9±0.8 mg/dL对3.0±0.8 mg/dL，p≤0.01）。到喂养第7天时，热烧伤组仍存在低磷血症趋势（2.7±1.2 mg/dL对3.3±0.6 mg/dL，p≤0.04）。热烧伤组和多发伤组之间的尿磷排泄差异无统计学意义（第1周分别为271±213 mg/d对171±181 mg/d，第2周分别为320±289 mg/d对258±184 mg/d）。热烧伤患者和多发伤患者之间的尿磷清除率、磷排泄分数或肾阈磷浓度也无显著差异。在营养支持期间，尽管热烧伤患者的磷摄入量显著高于多发伤患者，但其血清磷浓度仍较低。与营养支持期间的多发伤患者相比，肾脏对磷的调节对热烧伤患者中观察到的严重低磷血症没有显著影响。
