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不同类型急性神经损伤患者并发低钠血症的临床特征及预后分析 被引量:2

The clinical characteristics and prognosis of patients with different types of acute nerve injurycomplicated with hyponatremia
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摘要 目的评价不同类型急性神经损伤患者低钠血症的发病情况、临床特征、治疗方法及预后。方法选取2015—03—2017—02重庆市急救医疗中心治疗的急性神经损伤患者550例。收集患者的临床资料,根据患者原发疾病不同,将患者分为创伤性脑损伤(TBI)组、肿瘤组、蛛网膜下腔出血(SAH)组与脑实质内出血(IPH)组,比较患者的临床指标与预后指标。进一步将患者分为低钠血症组与非低钠血症组,比较以上各组患者的临床资料。结果超过半数患者(296/550,53.8%)并发低钠血症,大多数低钠血症患者(209/296,70.6%)为轻度。与肿瘤和IPH组比较,SAH组和TBI组患者低钠血症发生率明显提高(均P〈0.05)。共有34.2%(188/550)的患者进行了血Na+纠正治疗,与肿瘤组和IPH组比较,SAH组和TBI组患者进行血Na+纠正治疗的患者百分率明显提高(均P〈0.05)。最常见的血Na‘纠正治疗指征为血Na+下降(111/188,59.0%)、脑水肿伴精神状态变化(34/188,18.1%)。对于血Na+纠正治疗(n=188)患者,输注高渗盐水(137/188,72.9%)是最常见的初始治疗方案,其次是口服氯化钠片(59/188,31.4%)。有62.2%(117/188)的患者对血Na+纠正治疗有响应,静滴高渗盐水24h后患者的血Na‘提高值最大,为(6.57±0.96)mmol/L,其次为体液限制(5.62±1.16)mmol/L与口服氯化钠片(3.51±0.90)mmol/L。低钠血症组预后良好率明显低于非低钠血症组[49.0%(145/296)VS.59.1%(150/254),X2=5.573,P=0.018],低钠血症组患者ICU治疗时间[(8.58±1.86)dVS.(4.23±1.18)d,t=32.133,P〈0.001]和住院时间[(13.79±2.46)dVS.(7.33±1.30)d,t=37.587,P〈0.001]明显高于非低钠血症组。结论急性神经损伤患者低钠血症发生率较高,患者通常� Objective To evaluate the incidence, clinical features, treatment and prognosis of hyponatremia in patients with different types of acute nerve injuries. Methods A total of 550 patients with acute nerve injury treated in our hospital were selected. The clinical data of the patients were collected. The patients were divided into traumatic brain injury (TBI) group, tumor group, subarachnoid hemorrhage (SAH) group and intraparenchymal hemorrhage (IPH) group according to the different primary diseases of the patients. The clinical and prognostic indicators were compared. The patients were divided into hyponatremia group and non - hyponatremia group. The clinical data of thepatients in each group were compared. Results More than half of the patients ( 296/550, 53.8% ) developed hyponatremia. Most hyponatremia patients (209/296, 70.6% ) were mild. Compared with the tumor group and the IPH group, the incidence of hyponatremia in patients with SAH and TBI increased significantly (all P 〈0.05). A total of 34.2% (188/550) patients underwent blood sodium corrective therapy, and compared with the tumor group and the IPH group, the percentage of patients with SAH and TBI undergoing blood sodium corrective therapy improved significantly ( all P 〈 0. 05 ). The most common treatment indications were the decrease in serum sodium (111/188, 59. 0%), cerebral edema with mental state changes (34/188, 18.1% ). For the patients underwent blood sodium corrective therapy ( n = 188 ), infusion of hypertonic saline ( 137/188, 72.9% ) is the most common initial treatment for blood sodium corrective therapy, followed by oral sodium chloride (59/188, 31.4% ). The 62.2% of patients (117/188) with blood sodium corrective therapy responded to the blood sodium corrective therapy, and the highest increase in blood Na after intravenous infusion of hypertonic saline 24 h was (6.57 ±0.96) mmol/L. The second was fluid restriction (5.62 ±1.16) mmol/L and oral sodium chloride (3.51
作者 杨柳 张敏 贺曦 王兴 Yang Liu, Zhang Min, He Xi, Wang Xing(Department of Neurology, Chongqing Emergency Medical Center, Chongqing 400014, China)
出处 《中国急救医学》 CSCD 北大核心 2018年第2期159-163,共5页 Chinese Journal of Critical Care Medicine
关键词 低钠血症 神经损伤 危重症 治疗 Hyponatremia Nerve injury Critical illness Treatment
作者简介 杨柳(1979-),女,硕士,副主任医师,E—mail:cqyltg@sina.com。
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