创伤性脑损伤对危重症多发创伤患者钾磷体内平衡的影响。

Influence of traumatic brain injury on potassium and phosphorus homeostasis in critically ill multiple trauma patients.

机构信息

Department of Clinical Pharmacy, University of Tennessee Health Science Center, Memphis, Tennessee, USA.

出版信息

Nutrition. 2010 Jul-Aug;26(7-8):784-90. doi: 10.1016/j.nut.2009.08.013. Epub 2009 Dec 16.

DOI:10.1016/j.nut.2009.08.013

PMID:20018481

Abstract

OBJECTIVE

The intent of this study was to ascertain whether multiple trauma patients with traumatic brain injury (TBI) had lower serum concentrations of potassium and phosphorus and required more aggressive supplementation than multiple trauma patients without TBI.

METHODS

Ventilator-dependent adult patients without renal impairment who were admitted to the trauma intensive care unit or neurosurgical intensive care unit and who received enteral nutrition were evaluated for the first 14 d after hospital admission. Patients were grouped according to the presence or absence of TBI. Target serum concentrations for potassium and phosphorus were 4 mEq/L and 4 mg/dL, respectively. Electrolyte repletion therapy was given according to the nutritional support service guidelines.

RESULTS

Fifty trauma patients (25 with and without TBI) were studied. Daily serum potassium concentrations were consistently lower for those with TBI (P < or = 0.001), whereas the mean net potassium intake was greater (1.3 +/- 0.5 versus 0.7 +/- 0.3 mEq x kg(-1) x d(-1), respectively, P < or = 0.001). Serial serum phosphorus concentrations were similar between groups (P = NS) except for a significantly lower serum phosphorus concentration for trauma patients with TBI on day 3 after hospital admission (2.5 +/- 0.5 versus 2.9 +/- 0.7 mg/dL, respectively, P < or = 0.05). However, the mean net phosphorus intake was significantly greater for trauma patients with TBI (0.65 +/- 0.25 versus 0.45 +/- 0.17 mmol x kg(-1) x d(-1), P < or = 0.001).

CONCLUSION

Potassium and phosphorus requirements are greater for multiple trauma patients with TBI compared with those without TBI.

摘要

目的

本研究旨在确定创伤性脑损伤（TBI）患者与无 TBI 的多发伤患者相比，血清钾和磷浓度是否较低，是否需要更积极的补充。

方法

对无肾功能损害、入住创伤重症监护病房或神经外科重症监护病房并接受肠内营养的呼吸机依赖成年患者，在入院后第 14 天内进行评估。根据是否存在 TBI 将患者分组。钾和磷的目标血清浓度分别为 4mEq/L 和 4mg/dL。根据营养支持服务指南给予电解质补充治疗。

结果

研究了 50 例创伤患者（25 例有 TBI，25 例无 TBI）。TBI 患者的每日血清钾浓度始终较低（P≤0.001），而平均净钾摄入量较大（分别为 1.3±0.5 和 0.7±0.3mEq x kg(-1) x d(-1)，P≤0.001）。两组间血清磷浓度的变化相似（P=NS），但 TBI 创伤患者入院后第 3 天的血清磷浓度明显较低（分别为 2.5±0.5 和 2.9±0.7mg/dL，P≤0.05）。然而，TBI 创伤患者的平均净磷摄入量明显较高（分别为 0.65±0.25 和 0.45±0.17mmol x kg(-1) x d(-1)，P≤0.001）。