重症脑卒中患者急性肾损伤发生情况及预后与高钠血症关系探讨  

Investigate of the relationship between the occurrence and prognosis of acute kidney injury and hypernatremia in severe stroke patients

作　　者：孙亚玲[1] 谷未强 刘欣[1] 

机构地区：[1]北京市昌平区中医院重症医学科,102200

出　　处：《中华临床医师杂志（电子版）》2013年第20期40-43,共4页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的分析探讨重症脑卒中患者急性肾损伤（AKI）发生情况及预后与高钠血症的关系。方法回顾分析我院ICU 2010年1月至2012年12月收治的重症脑卒中患者270例,所有患者均监测入院0 h、24 h、48 h、72 h、7 d及此后隔日1次的肾功能、电解质,直至检验值恢复正常范围或患者出院或死亡,分析患者急性肾损伤发生情况及预后与高钠血症的关系,所有患者均进行APACHEⅡ评分并经过积极的病因和对症治疗。结果纳入本研究的270例患者中,发生高钠血症的50例,发生率18.5%;发生AKI的41例,发生率15.2%。高钠血症50例中,急性脑出血27例,急性脑梗死15例,蛛网膜下腔出血8例;其中男30例,女20例;平均年龄（58.12±18.33）岁;平均APACHEⅡ评分（24.0±7.9）分;平均血钠水平（159±10）mmol/L;发生AKI 14例,发生率28.0%（非高钠血症发生率12.3%）,且与血钠增高程度成正相关;死亡18例,病死率36%,死亡组的血钠水平、APACHEⅡ评分均明显高于存活组;死亡组AKI发生率（9/18,50%）亦明显高于存活组（5/32,15.6%）。结论重症脑卒中发生高钠血症多发生在发病后3~8 d,血钠值越高,AKI的发生率越高,APACHEⅡ评分越高;且高钠血症发生在卒中后7 d左右的,预后越差,死亡率越高。Objective To analyze and discuss the relationship between the occurrence and prognosis of acute kidney injury and hypernatremia in severe stroke patients. Methods We retrospectively analyzed 270 cases of severe stroke patients who were treated in ICU of our hospital from January 2010 to December 2012.All patients were monitored the renal function and electrolyte after entering the hospital 0 h, 24 h, 48 h, 72 h, 7 d and thereafter every other day until the test values returned to normal range or patient discharge from hospital or death. We analyzed the relationship between the occurrence, prognosis of acute kidney injury patients and hypernatremia. Results Among the 270 cases, there were 50 cases of hypernatremia, The incidence rate was 18.5%, while 41 cases of acute kidney injury, the incidence rate was 15.2%. Among the 50 cases of hypernatremia, 27 case of acute intracerebral hemorrhage, 15 cases of acute cerebral infarction and 8 cases of subarachnoid hemorrhage, of which 30 males and 20 females with average age of （58.12±18.33） years old, average APACHE II score （24±7） points, average serum sodium level （159q-10）mmol/L. There were 14 cases of AKI, The incidence rate was 28.0% （the non-hypernatremia incidence rate was 12.3%）, and positively correlated with the degree of increase serum sodium. There were 18 cases of death, the mortality rate was 36%. The serum sodium levels and APACHE II scores in the death group were significantly higher than that in the survival group. The AKI incidence rate （9/18, 50%） in death group was significantly higher than in the survival group （5/32, 15.6%）. Conclusions The hypernatremia mostly occur 3-8 days after patients are attacked by severe stroke, the higher of serum sodium, the higher of the incidence rate of AKI and the higher of APACHE II score. Especially, the worse of prognosis, the higher of the mortality rate if the hypernatremia occurred around 7 days after the acute stroke.

关 键 词：卒中 高钠血症 预后 急性肾损伤 

分 类 号：R743.3[医药卫生—神经病学与精神病学]