血钠水平与重型颅脑损伤预后相关性研究  

Relationship between serum sodium level and prognosis of severe craniocerebral injury

作　　者：王斌 成振林 白赟 赵小霞 周大帅 Wang Bin;Cheng Zhenlin;Bai Yun;Zhao Xiaoxia;Zhou Dashuai(Department of Neurosurgery,Zhangye People's Hospital Affiliated to Hexi University,Zhangye 734000,China)

机构地区：[1]河西学院附属张掖人民医院神经外科,张掖734000

出　　处：《国际外科学杂志》2023年第4期265-269,共5页International Journal of Surgery

基　　金：甘肃省张掖市市级科技计划-B类计划项目(ZY2022BJ02)。

摘　　要：目的探讨重型颅脑损伤不同血钠水平对患者病情及预后的影响。方法采用回顾性队列研究方法分析2020年1月-2022年10月河西学院附属张掖人民医院收治的150例重型颅脑损伤的病例资料,根据入院后第1天及脑水肿高峰期间(伤后2~4 d)、伤后7 d检测的5次血钠值,得出血钠代谢失调者102例,根据血钠水平分为两组,低钠组:血钠平均值<135 mmol/L者43例,高钠组:血钠平均值>145 mmol/L者59例。分析患者钠离子代谢失衡特点及血钠水平与伤后2周格拉斯哥昏迷评分(GCS)、格拉斯哥预后评分(GOS)、急性生理与慢性健康评分(APACHEⅡ)之间的关系。正态分布的计量资料以均数±标准差(x±s)表示,组间比较采用t检验;计数资料以例数或百分率(%)表示,组间比较采用χ^(2)检验。结果本组患者伤后急性期钠代谢失衡率为68.00%(102/150),其中高钠血症发生率为57.84%(59/102),低钠血症为42.16%(43/102),在伤后7 d时钠代谢失衡率明显高于伤后即刻,高钠血症的发生时间早于低钠血症、持续时间长于低钠血症(P<0.05)。低钠组与GCS(R=0.523)、GOS(R=0.367)、APACHEⅡ(R=-0.453)评分无相关性(P>0.05),但GCS(R=-0.448)及GOS(R=-0.486)评分与高钠组血钠水平呈负相关(P<0.05),高钠组与APACHEⅡ呈正相关(R=0.477,P<0.05)。结论重型颅脑损伤患者常伴发血钠紊乱,低钠血症在短期内可以纠正,对患者病情及预后无影响,但高钠血症严重影响患者神志恢复、预后转归、生活质量。Objective To explore the effect of different blood sodium levels on the condition and prognosis of patients with severe craniocerebral injury.Methods A retrospective cohort study was conducted on 150 cases of severe craniocerebral injury admitted to Zhangye People′s Hospital Affiliated to Hexi University from January 2020 to October 2022.According to the five blood sodium values measured on the first day after admission and during the peak period of brain edema(2-4 days after injury)and 7 days after injury,102 cases of blood sodium metabolic disorder,43 cases of low sodium group:average blood sodium value<135 mmol/L,59 cases of high sodium group:average blood sodium value>145 mmol/L.The characteristics of sodium ion metabolism imbalance and the relationship between serum sodium level and Glasgow coma score(GCS),Glasgow prognosis score(GOS)and APACHE Ⅱ score at 2 weeks after injury were analyzed.Measurement data with normal distribution were represented as mean±standard deviation(x±s),and comparison between groups was conducted using the t-test.count data were expressed as cases or percentages(%),and comparison between groups was conducted using the Chi-square test.Results The imbalance rate of sodium metabolism in the acute phase after injury was 68.00%(102/150),including 57.84%(59/102)of hypernatremia and 42.16%(43/102)of hyponatremia.The imbalance rate of sodium metabolism at 7 days after injury was significantly higher than that immediately after injury.Hypernatremia occurred earlier than hyponatremia and lasted longer than hyponatremia(P<0.05).There was no correlation between the low sodium group and the scores of GCS(R=0.523),GOS(R=0.367),APACHE Ⅱ(R=-0.453)(P>0.05),but the scores of GCS(R=-0.448)and GOS(R=-0.486)were negatively correlated with the blood sodium level of the high sodium group(P<0.05),and the high sodium group was positively correlated with the scores of APACHEⅡ(R=0.477,P<0.05).Conclusions Patients with severe craniocerebral injury are often accompanied by blood sodium disorder.Hypona

关 键 词：高钠血症 低钠血症 预后 颅脑损伤 

分 类 号：R651.15[医药卫生—外科学] R589.4[医药卫生—临床医学]