中重度颅脑损伤患者血钠紊乱发生率与受伤部位及临床预后的相关性  

Incidence of sodium disorder in the moderate-severe traumatic brain injury patients and its relationship with prognosis and the injured part

作　　者：代金龙[1] 李继波[1] 杜向阳[1] 许力[2] 殷亮[2] DAI Jin-long;LI Ji-bo;DU Xiang-yang(Department of Surgery, Lu＇ an Hospital of Traditional Chinese, Lu＇ an, Anhui 237000, Chin)

机构地区：[1]六安市中医院外二科,安徽六安237000 [2]蚌埠医学院第一附属医院神经内科,安徽蚌埠233004

出　　处：《中华全科医学》2018年第7期1088-1090,共3页Chinese Journal of General Practice

基　　金：安徽省卫生厅重点项目(KJ2015A248)

摘　　要：目的研究中重度颅脑损伤患者血钠紊乱的发生率及其与颅内血肿发生部位的关系,以及血钠异常与患者死亡率的关系。方法该研究为一项回顾性研究,研究对象为2014年1月—2017年5月六安市中医院收治的452例经病史及头颅CT证实为中重度颅脑损伤患者并符合本研究的入组标准。入院后记录患者的一般资料,同时应用颅脑CT及GCS评分对患者的病情进行评估,并定位患者的颅内血肿发生部位,并以患者入院即刻的血钠水平、住院期间每日血钠浓度、意识障碍的程度及死亡率为研究变量。采用SPSS 20.0统计软件对中重度颅脑损伤患者血钠异常发生率与颅脑损伤不同部位及死亡率进行分析。结果所有患者中血钠异常的发生率为45.1%(204/452),其中高钠血症128例,低钠血症76例。50%的患者入院即刻即有血钠异常。50%的低钠血症患者在系列检查过程中,血钠浓度低于125 mmol/L;不同受伤部位血钠异常发生率的差异有统计学意义(P<0.05),硬膜下血肿、脑内血肿及弥漫性轴索损伤的患者发生血钠紊乱的几率较高;血钠异常组患者死亡率高于正常组(P<0.05)。结论中重度颅脑损伤患者发生血钠异常的比例较高,其损伤部位与血钠异常发生率有相关性,其中罹患硬膜下血肿、脑内血肿及弥漫性轴索损伤的患者发生血钠紊乱的几率较高;发生血钠异常的中重度颅脑损伤患者的死亡率较高。Objective To determine the incidence of sodium disorder in the moderate-severe traumatic brain injury pa- tients and its association with the location of intracranial hematoma and mortality of patients. Methods A total of 452 patients faced moderate and severe traumatic brain injuries diagnostic criteria in our hospital from January, 2014 to May, 2017 were enrolled into this study. The patient＇s general information was recorded after admission. All the patients un- derwent cerebral computed tomography to locate intracranial hematoma and received GCS. The serum sodium level imme- diate after admission and duration the stay in hospital, the degree of conscious disturbance and mortality were as research variable. SPSS 20.0 was used to analyze the relationship between the incidence of sodium disorders and the location of in- tracranial hematoma and mortality. Results The incidence of sodium disturbances was 45.1% （204/452） ： 128 patients were with hypernatremia and 76 with hyponatremia. Sodium disturbances were detected in the first sample in 50% of the patients. The serum sodium level in 50% of the patients with hyponatremia was less than 125 mmol/L by a series of tests. There was significant difference in the incidence of sodium disorders among the patients with different location of in- jury （P 〈 0.5）. The patients who got subdural hematoma, the brain hematoma and diffuse axonal injury would have a better chance of sodium disorders. The mortality of patients with abnormal blood sodium was higher than that in the nor- mal group. Conclusion The incidence of sodium disorder in the moderate-severe traumatic brain injury patients is high- er, especially in the patients get a subdural hematoma, brain hematoma and diffuse axonal injury. Abnormal blood sodi- um may be associated with mortality.

关 键 词：颅脑损伤 高钠血症 低钠血症 

分 类 号：R651.15[医药卫生—外科学] R591.1[医药卫生—临床医学]