动脉瘤夹闭术后低钠血症相关危险因素分析及临床特点  

Risk factors and clinical characteristics of hyponatremia in postoperative patients with aneurysm

作　　者：蔡建勇[1] 巴华君[1] 陆川[1] 孙军[1] 

机构地区：[1]浙江省温州市中心医院(原温州市第二人民医院)神经外科,325000

出　　处：《中国医师进修杂志》2013年第11期28-30,共3页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨动脉瘤夹闭术后低钠血症的相关危险因素，并对其临床特点进行分析，为其临床的诊断及治疗提供参考。方法共纳入120例行动脉瘤夹闭术患者，详细记录患者的病史及基本信息，根据其是否发生低钠血症分为两组，应用多因素Logistic回归分析进行多因素分析。结果120例行动脉瘤夹闭术患者术后有45例（37．5％）出现低钠血症（病例组），血钠（125．2±10．1）mmol／L，出现低钠血症时间（8．2±0．8）d，其中第1个高峰（术后1～3d）15例，第2个高峰（术后8～9d）25例，其余时间5例；颈内动脉系统动脉瘤39例，椎．基底动脉系统动脉瘤6例。单因素分析结果表明，对照组和病例组年龄、术前格拉斯哥昏迷量表（GCS）评分、高血压病史、糖尿病病史、急诊手术、动脉瘤大小及中动脉动脉瘤比例比较差异有统计学意义[（48．7±8．4）岁比（54．7±8．4）岁、（14．4±3．1）分比（10.3±3．4）分、26．7％（20／75）比60．0％（27／45）、33-3％（25／75）比62．2％（28，45）、32．0％（24／75）比62．2％（28／45）、（0．9±0．3）cm比（1．4±0．4）cm、24．0％（18／75）比42．2％（19，45），P〈0．01或〈0．05]。进一步行多因素分析结果表明，术前GCS评分下降、急诊手术是动脉瘤夹闭术后出现低钠血症的独立危险因素（P〈0．05）。结论术后1-3d及8～9d是动脉瘤夹闭术后出现低钠血症的高峰，对于不同高峰阶段需要采用不同的治疗方法。术前GCS评分下降、急诊手术是动脉瘤夹闭术后出现低钠血症的独立危险因素，临床工作中需重视上述危险因素并给予相应的治疗及预防。Objective To explore the risk factors of hyponatremia in postoperative patients with aneurysm and analyze the clinical characteristics in order to provide reference for clinic. Methods Participants included 120 patients who treated by aneurysm occlusion. Detailed recorded the patient＇s history and basic information. The patients with hyponatremia were in case group, and other patients were in control group. The risk factors of hyponatremia were analyzed. Results Forty-five patients （37.5%） occurred hyponatremia after operation. The level of natrium was （125.2 ± 10.1 ） mmol/L, the average time of appear hyponatremia was （8.2 ± 0.8 ） d, 15 patients were in the first peak （postoperative 1 - 3 d）, 25 patients were in the second peak （postoperative 8 -9 d）,5 patients occurred hyponatremia at other time. Thirty-nine patients were internal carotid artery aneurysms, 6 patients were vertehrobasilar artery aneurysms. Single factor analysis showed that the age, preoperative GCS scores, history of hypertension and diabetes, emergency operation, the size of arterial aneurysms, medium-sized aneurysm of artery between two groups had significant difference [ （48.7 ± 8.4） years vs. （54.7 ± 8.4） years, （14.4± 3.1 ） scores vs. （10.3± 3.4） scores,26.7% （20115） vs. 60.0% （27/45）,33.3% （25115） vs. 62.2% （28/45）,32.0% （24115） vs. 62.2%（28/45）, （0.9 ±0.3） cm vs.（1.4 ±0.4） cm,24.0%（18/75） vs. 42.2%（19/45）,P 〈 0.01 or 〈0.05]. Multi- factors regression analysis showed that preoperative GCS scores, emergency operation were the independent risk factors of hyponatremia （P 〈 0.05 ）. Conclusions Postoperative 1-3 d and 8-9 d axe the peak stage of hyponatremia. Different treatment should be adopted according the peak stage. Lower scores of preoperative GCS and emergency operation are the independent risk factors of hyponatremia. Clinical work need to pay more attention to the risk factors, appropriate treatment and prevention.

关 键 词：危险因素 低钠血症 回归分析 动脉瘤夹闭术后 

分 类 号：R543.5[医药卫生—心血管疾病]