钠代谢紊乱对重型颅脑损伤患者病情及预后评价临床应用研究  

The Evaluating of Disorders of Sodium Metabolism in Condition and Prognosis of Patients with Severe Craniocerebral Injury

作　　者：江川 

机构地区：[1]重庆市长寿区人民医院神经外科,重庆长寿区401220

出　　处：《河北医学》2016年第1期102-105,共4页Hebei Medicine

基　　金：重庆市卫生局医学科研计划资助项目;(编号:2010-2-443)

摘　　要：目的:研究血钠紊乱程度在重型颅脑损伤患者病情及预后评估的临床应用价值。方法:149例重型颅脑损伤根据血钠水平分为低钠血症组47例,血钠正常组64例,高钠血症组38例,比较三组重型颅脑损伤患者格拉斯歌昏迷评分以及预后情况。结果:血钠正常组、低钠血症组、高钠血症组三组入院GCS评分依次降低,平均APACHEⅡ评分依次升高;高钠血症组死亡率为25.8%,高于血钠正常组、低钠血症组,差异有统计学意义(P<0.05),血钠正常组死亡率与低钠血症组无统计学差异(P>0.05);低钠血症组、血钠正常组钠离子浓度与GCS评分及平均APACHEⅡ评分均无相关性(P>0.05),高钠血症组钠离子浓度与GCS评分呈负相关(r=-0.65,P<0.05),与平均APACHEⅡ评分均呈正相关(r=0.59,P<0.05)。结论:高钠血症在重型颅脑损伤患者中较为凶险,具有较高的死亡率,钠离子的增高程度与疾病严重程度相关,可作为重型颅脑损伤患者并发高钠血症预后的评估指标。Objective： To study the clinical application value of evaluation of sodium metablism condition and prognosis of patients with severe brain injury. Method： 149 cases with severe brain injury,according to serum sodium level,were divided into hyponatremia group（ 47 cases）,normal blood sodium group（ 64 cases）,and hypernatremia group 38 cases. The class sengscoma scale and progmosis of the three groups of patients with seven craniocbnebral injury were compared. Result： Score of normal blood sodium group,hyponatremia group,hypernatremia group decreased inturn,the average APACHE score; in hypernatremia group,a mortality rate of 25.8%,higher than that in normal blood sodium group and hyponatremia group,the difference was statistically significant（ P〈0.05）,the death rate of the normal blood sodium group and hyponatremia group showed no significant difference（ P〉0.05）; sodium ionic concentration and GCS score and the average APACHE score of the hyponatremia group and the normal blood sodium group were not correlated（ P〉0.05）,the ionic concentration and GCS score of hypernatremia group were negatively correlated（ r=-0.65,P〈0.05）,and the average APACHE score was positively related to II（ r = 0.59,P〈0.05）.Conclusion： Hypernatremia in patients with severe craniocerebral injury is dangerous,with high mortality,the sodium ion level correlates with disease severity,which can beuseed as evaluation index in patients with severe craniocerebral injury and complicated with hypernatremia prognosis.

关 键 词：重型颅脑损伤 低钠血症 高钠血症 格拉斯歌昏迷评分 急性生理及慢性健康状况评分 

分 类 号：R651.15[医药卫生—外科学]