创伤性脑损伤并发低钠血症的危险因素分析  

Risk factors for hyponatremia in patients with traumatic brain injury

作　　者：胡岚 李谦益 梁栋 祁洋 陈旭光 李洪超 姚文飞 陆一鸣[2] HU Lan;LI Qianyi;LIANG Dong;QI Yang;CHENG Xuguang;LI Hongchao;YAO Wenfei;LU Yiming(Department of Emergency,Ruijin Hospital North,School of Medicine,Shanghai Jiaotong University,Shanghai,201801,China;Department of Emergency,Ruijin Hospital,School of Medicine,Shanghai Jiaotong University)

机构地区：[1]上海交通大学医学院附属瑞金医院北院急诊科,上海201800 [2]上海交通大学医学院附属瑞金医院急诊科,上海201800

出　　处：《临床急诊杂志》2020年第7期572-575,580,共5页Journal of Clinical Emergency

基　　金：瑞金北院创建区域性院内外急救一体化管理模式探索(No:SHDC2015608);医疗应急响应及救援决策系统在交通事故伤害等突发公共事件中的整合式研究(No:201540322)。

摘　　要：目的:创伤性脑损伤(TBI)是神经外科常见的损伤,其中低钠血症的发生率约为33%。本研究探讨了低钠血症与TBI不同损伤部位及其他合并因素之间的关系;方法:对我院2017-01—2020-01期间收治的126例TBI患者进行回顾性分析。采用χ^2检验分析低钠血症的发生与TBI不同损伤部位、格拉斯哥昏迷评分(GCS)、是否行手术治疗、脑水肿、颅底骨折之间的关系。结果:126例患者中,38例患者(30.16%)出现低钠血症,88例患者(69.84%)血钠正常。TBI患者发生低钠血症与额部损伤(P=0.027)、弥散性轴索损伤(P=0.02)、合并颅底骨折(P=0.025)、合并脑水肿(P=0.044)相关,与颞部损伤、枕部损伤、是否手术、GCS评分无关。结论:研究表明,TBI额部损伤、弥漫性轴索损伤、合并颅底骨折、合并脑水肿患者易发生低钠血症,而颞部损伤、GCS评分、是否手术均不是低钠血症的危险因素。Objective:Traumatic brain injury is a common injury in neurosurgery,and the incidence of hyponatremia is about 33%.The incidence of hyponatremia after traumatic brain injury was 33%.Hyponatremia is one of the leading causes of disability and/or death in TBI patients.This study investigated the relationship between hyponatremia and different injury sites and types of TBI.Method:The TBI patients admitted to our hospital were retrospectively analyzed.Theχ^2 test was used to analyze the relationship between the occurrence of hyponatremia and different injury sites/types of TBI,glasgow coma score(GCS),whether to undergo surgical treatment,and the presence of brain edema/skull base fracture or not.Result:Of the 126 patients,38(30.16%)developed hyponatremia and 88(69.84%)had normal serum sodium.Hyponatremia in TBI Patients was associated with frontal injury(P=0.027),diffuse axonal injury(P=0.02),combine with skull base fracture(P=0.025),and combined brain edema(P=0.044),but not with temporal injury,occipital injury,surgery,or GCS score.Conclusion:Statistical analysis shows that patients with TBI frontal injury,diffuse axonal injury,combined skull base fracture,and combined brain edema are Prone to hyponatremia,while temporal injury,GCS score,and surgery are not risk factors for hyponatremia.

关 键 词：创伤性颅脑损伤 低钠血症 脑水肿 格拉斯哥昏迷评分 

分 类 号：R641[医药卫生—外科学]