重症患者并发高钠血症的临床研究  

Clinical study of severe patients with hypernatremia

作　　者：张丰[1] 张家留[1] 高觉民[2] 潘昕[3] 于如同[3] 

机构地区：[1]江苏省中西医结合医院,江苏南京210028 [2]江苏省中医院,江苏南京210029 [3]徐州医学院附属医院,江苏徐州221002

出　　处：《中国急救医学》2013年第3期281-284,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的研究重症患者并发高钠血症的危险因素及对患者预后的影响。方法对人住ICU的高钠血症患者进行回顾性分析（其中我们对高钠血症的诊断标准是血钠值≥150mmo]／L）。并采用1：2（观察组：控制组）的比例方式进行有效管理与观察。结果40例人住ICU并发高钠血症的患者[血钠（141±3）mmol／L～（156±6）mmol／L]与控制组相比（80例），其中重症感染为13％比10％，低钾血症10％比15％，肾功能衰竭18％比12％，低蛋白血症21％比3％，甘露醇应用10％比1％，盐溶液应用75％比39％（P〈0．05），均与高钠血症有直接的关系。通常这些病例会出现多尿症状（40±5）mL／kg，而且这些病例的致死率很高（43％比10％）（P〈0．001）。由此看出高钠血症是重症患者高致死率的独立危险因素。结论重症患者并发高钠血症都是多种因素共同作用促进机体肾失水，而在纠正机体失水的时候却给予水过少，过多输入相对较高涨的盐溶液，以致矫枉过正。做好静脉输液的管理是预防高钠血症的关键。Objective To study the risk factors and mechanisms of hypernatremia in critically ill patients. Methods All the patients admitted to the intensive care unit （ICU） were retrospectively analyzed, and the ratio of observation group to control group was 1：2 for effective management and observation. Diagnostic criteria of hypernatremia was serum sodium ≥150 mmol/L in the ICU. Results Forty cases with 1CU - acquired hypematremia [ （ 141 ± 3 ） mmol/L to （ 156 ± 6 ） mmol/L] were compared with eighty controls. Sepsis （ 13% versus 10% ）, hypokalemia（ 10% versus 15% ）, renal dysfunction （ 18% versus 12% ）, hypoalbuminaemia （21% versus 3% ）, the use of mannitol （ 10% versus 1% ）and the use of hypertonic sodium solutions （75% versus 39% ） were more common in cases （P 〈0.05 for all）and were independently associated with hypernatremia. On average, the cases with a positive fluid balance were polyuric [ （40 ± 5 ） mL/kg], and their mortality was higher （43% versus 10%, P 〈0. 001 ）, which showed hypematremia was an independent predictor Conclusion Hypematremiaseems to develop in critically ill patients because various factors promote renal water loss, which is then corrected with too little water or overcorrected with relatively hypertonic fluids. Adjustments in intravenous fluid regimens may prevent hypernatremia.

关 键 词：高钠血症 重症 静脉输液 致死率 

分 类 号：R644[医药卫生—外科学]