113例重症患者高钠血症与尿钠的关系分析  

Relationship between hypernatremia and urine sodium in 133 patients with critical illness

作　　者：杜萌[1] 常平[1] 余英典[1] 龙国梁[1] 唐颖[1] 赵明[1] 莫冰[1] 岑仲然[1] 

机构地区：[1]南方医科大学珠江医院重症医学科,广州510282

出　　处：《中华急诊医学杂志》2015年第10期1151-1154,共4页Chinese Journal of Emergency Medicine

摘　　要：目的 探讨重症患者高钠血症与尿钠,及尿钠与疾病危重程度、预后的关系.方法 收集共113例373例日次ICU患者资料.按照血钠正常范围（135 mmol/L ～ 145 mmol/L）分为高钠血症组（n=262）、正常血钠组（n=84）、低钠血症组（n =27）3组,并按照24 h尿钠正常范围（130 mmol ～ 260 mmol）分为低尿钠组（n=158）、正常尿钠组（n=146）、高尿钠组（n=69）3组,比较各组间血钠、出入量、24 h尿钠、钠摄入量、肌酐等,并进一步分析尿钠与疾病危重程度及预后的关系.结果 ①高钠血症组的尿钠低于正常血钠组[（156.8±109.1） mmol vs.（193.4±127.1）mmol,P＜0.05].②低尿钠组肌酐值及APACHEⅡ评分均高于正常尿钠组[（134.0±88.6） μmol/L vs.（103.3±55.5） μmol/L,（26.5±10.4） vs.（19.7±6.9）,均P＜0.05].③低尿钠组28天病死率高于正常尿钠组（60.7％ vs.16.7％,P＜0.01）.结论 尿钠排泄降低是高钠血症发生的重要原因,且与病情危重程度及预后相关.Objective To discuss the relationship between hypernatremia and urine sodium,as well as the relationship between urine sodium and severity of disease and prognosis.Methods Information of 113 ICU patients （373 days） was collected.All cases were divided into 3 groups according to the normal range of blood sodium level （135 mmol/L-145 mmol/L）,as hypernatremia group （n =262）,normal blood sodium group （n =84） and hyponatremia group （n =27）.All cases were divided into another 3 groups according to the normal range of 24 h urine sodium level （130 mmol-260 mmol）,as low urine sodium group （n =158）,normal urine sodium group （n =146） and high urine sodium group （n =69）.Blood sodium level,intake and output volume,24 h urine sodium level,amount of sodium intake,creatinine and etc.were compared among the groups.Relationship between urine sodium and severity of disease,as well as relationship between urine sodium and prognosis were further analyzed.Results ①Average level of urine sodium in hypernatremia group was lower than that in normal blood sodium group [（156.8 ± 109.1） mmol vs.（193.4 ± 127.1） mmol,P 〈 0.05].②Average creatinine level and average APACHE Ⅱ score in low urine sodium group were both higher than those in normal urine sodium group [（134.0 ± 88.6） μmol/Lvs.（103.3 ± 55.5） μmol/L,（26.5 ± 10.4） vs.（19.7 ± 6.9）,and P 〈 0.05].③The 28-day mortality in low urine sodium group is higher than that in normal urine sodium group （60.7% vs.16.7%,P 〈0.01）.Conclusions Decrease in urine sodium excretion is an important cause for hypernatremia,and it＆#39;s related to the severity of disease and prognosis.

关 键 词：重症监护 危重病 电解质紊乱 高钠血症 24h尿钠 肌酐 APACHEⅡ评分 28 d病死率 

分 类 号：R589.4[医药卫生—内分泌]