重症患者血清钠水平对预后的影响

Influence of serum sodium level on prognosis in severe patients

摘要:

目的 探讨重症患者高钠血症的发生情况及血钠水平对预后的影响。方法 选取2016年1月—2018年1月天津医科大学总医院老年ICU预计住院时间>48?h的成年患者280例，入ICU后24?h内取血标本送检，按血钠水平分为正常血钠组（血钠135～145?mmol/L）、低血钠组（血钠<135?mmol/L）和高血钠组（血钠>145?mmol/L）。记录患者的一般情况、疾病组成、实验室指标、机械通气时间、ICU住院时间、预后等，并计算入ICU后24?h内的急性生理学和慢性健康状况评价Ⅱ评分（APACHEⅡ评分）和序贯器官衰竭（SOFA）评分；比较高血钠组与非高血钠组住院时间、病死率等指标。采用Logistic回归分析筛选重症患者死亡的危险因素。结果 纳入的280例重症患者中，非高血钠组197例，高血钠组83例，分别占总例数的70.4%和29.6%。高血钠组中严重脓毒症21例（25.3%）、肾功能不全15例（18.1%），与非高血纳组比较，差异有统计学意义（P?<0.05）。高血钠组与非高血钠组性别、年龄比较，差异无统计学意义（P?>0.05），在APACHEⅡ、住院时间及病死率方面差异有统计学意义（P?<0.05）。多因素Logistic分析显示，APACHEⅡ评分和血钠水平为影响重症患者死亡的独立危险因素（P?<0.05）。结论 APACHEⅡ评分和血钠水平为影响ICU重症患者死亡的独立危险因素。

Abstract:

Objective To investigate the incidence of hypernatremia in severe patients and the effect of serum sodium level on prognosis. Methods From January 2016 to January 2018, 280 adult patients with a projected hospitalization time of > 48?h in the geriatrical ICU of Tianjin medical university general hospital were selected. Blood samples were taken within 24 hours after admission to the ICU and sent for examination. According to the level of blood sodium, they were divided into normal blood sodium group (blood sodium between 135?mmol/L and 145?mmol/L), low blood sodium group (blood sodium < 135 mmol/L) and high blood sodium group (blood sodium > 145?mmol/L). General conditions of patients, diseases, laboratory indexes, mechanical ventilation time and ICU length of hospital stay and prognosis, etc. were recorded, and acute physiology and chronic health evaluation (APACHE II score) and sequential organ failure score (SOFA) after admission to ICU within 24?h were calculated; the hospitalization time and mortality of patients in the hypernatremia group and the non-hypernatremia group were compared. Logistic regression analysis was used to screen the risk factors of death in severe patients. Results Among the 280 patients, 83 cases were in the hypernatremia group and 197 cases were in the non-hypernatremia group, accounting for 29.6% and 70.4% of the total cases, respectively. The proportion of sepsis (21 cases, accounting for 25.3%) and renal insufficiency (15 cases, accounting for 18.1%) in the hypernatrium group was significantly increased compared with that in the non-hypernatrium group, with statistically significant differences (P?< 0.05). Compared with non-hypernatremia group, there was no significant difference in gender and age between hypernatremia group and non-hypernatremia group (P?>?0.05). The two groups have statistical significance in the APACHE II, length of hospital stay and mortality (P?