电解质紊乱与原发性脑干出血患者意识障碍转归的相关性分析  

Correlation of disturbance of electrolyte balance with outcome of disorders of consciousness in patients with primary brainstem hemorrhage

作　　者：孙娟 左诗怡 陈珍珍 刘国芳 蔡涵旭 胡志安[3] 刘勇 姚忠祥[3] SUN Juan;ZUO Shiyi;CHEN Zhenzhen;LIU Guofang;CAI Hanxu;HU Zhi'an;LIU Yong;YAO Zhongxiang(Department of Pain and Rehabilitation,Second Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing,400037;Department of Radiology,Second Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing,400037;Department of Physiology,Institute of Brain and Intelligence,College of Basic Medical Sciences,Army Medical University(Third Military Medical University),Chongqing,400038,China)

机构地区：[1]陆军军医大学(第三军医大学)第二附属医院:疼痛与康复医学科,重庆400037 [2]陆军军医大学(第三军医大学)第二附属医院放射科,重庆400037 [3]陆军军医大学(第三军医大学)基础医学院生理学教研室,脑与智能研究院,重庆400038

出　　处：《第三军医大学学报》2021年第15期1424-1429,共6页Journal of Third Military Medical University

基　　金：国家自然科学基金创新研究群体项目(31921003)。

摘　　要：目的探讨患者原发性脑干出血后电解质紊乱的特点及其与意识障碍转归的相关性。方法从陆军军医大学第二附属医院2010年1月1日至2020年9月1日收治的350例脑干出血患者中筛选出原发性脑干出血并进行标准化补液病例47例,根据意识状态分为无意识障碍组(n=21)、意识障碍组(n=21)和意识障碍转清醒组(n=5),收集全病程静脉血钠离子、钾离子、氯离子、阴离子间隙(AG)和二氧化碳(CO_(2))含量的检测结果,分析其均值、最大值、最小值、异常率、平均波动幅度等指标的变化规律和特点,并探讨其与意识障碍患者转归的关系。结果单因素方差分析进行组间比较发现,在无意识障碍组、意识障碍组和意识障碍转清醒组之间,氯离子、阴离子间隙的均值、最大值、最小值、异常率和平均波动幅度差异均具有统计学意义(P<0.05);而钠离子、钾离子和CO_2含量在上述3组之间,除CO_2含量的异常率和平均波动幅度之外,差异均无统计学意义。进一步进行组内多重比较分析发现,与无意识障碍组比较,氯离子和阴离子间隙在意识障碍组的均值、最大值、异常率和平均波动幅度均显著升高,而最小值显著降低(P<0.01);钾离子、阴离子间隙、CO_2含量在意识障碍转清醒组的异常率和平均波动幅度均显著升高(P<0.01),而钠离子和氯离子的差异均无统计学意义。结论电解质紊乱与原发性脑干出血的意识障碍程度密切相关,尤其是氯离子和阴离子间隙的异常率和平均波动幅度越高,意识障碍就越严重。Objective To investigate the characteristics of disturbance of electrolyte balance after primary brainstem hemorrhage(PBH)and their correlation with the outcome of patients with disorders of consciousness(DOC).Methods A retrospective survey was used to statistically analyze the clinical data of 350 patients with brainstem hemorrhage admitted to the Second Affiliated Hospital of Army Military Medical University from January 1,2010 to September 1,2020.With our strict inclusion and exclusion criteria,47 PBH cases undergoing standardized fluid replacement were screened out.Then they were divided into the non-DOC group(n=21),DOC group(n=21)and DOC translating to non-DOC group(n=5)according to their state of consciousness.The quantities of venous blood electrolyte and carbon dioxide during the whole duration of hospital stay were collected,and then analyzed for the changes of sodium,potassium,chloride,anion gap(AG)and CO2.Next,we analyzed the rule and characteristics of the changes of mean value,maximum value,minimum value,abnormal rate,average fluctuation range and other indicators,and explored their relationship with PBH.Results One-way analysis of variance(ANOVA)showed that there were significant differences in the mean value,maximum value,minimum value,abnormal rate and average fluctuation range of chloride ion and AG among the 3 groups(P<0.05).But in addition to the abnormal rate and average fluctuation range of CO2 content,there were no statistical differences in the contents of sodium ion,potassium ion and CO2 among the 3 groups.Further multiple intra-group comparative analysis indicated that the mean value,maximum value,abnormal rate and average fluctuation range of chloride ion and AG were significantly increased,while the minimum value was decreased in the DOC group than the non-DOC group(P<0.01).The abnormal rate and average fluctuation range of potassium ion,AG and CO2 content were significantly increased(P<0.01),but no statistical significance was seen in sodium and chloride in the DOC translating to non-D

关 键 词：原发性脑干出血 意识障碍 电解质紊乱 转归 氯离子 阴离子间隙 

分 类 号：R363.13[医药卫生—病理学] R743.34[医药卫生—基础医学]