不同类型急性神经损伤患者并发低钠血症的临床特征及预后分析

doi:10.3969/j.issn.1002-1949.2018.02.014

Chinese Journal of Critical Care Medicine

2018, Vol. 38

Issue (2): 159-163 DOI: 10.3969/j.issn.1002-1949.2018.02.014

The clinical characteristics and prognosis of patients with different types of acute nerve injury complicated with hyponatremia

Yang Liu, Zhang Min, He Xi, Wang Xing

Department of Neurology, Chongqing Emergency Medical Center, Chongqing 400014,China

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Abstract Objective To evaluate the incidence, clinical features, treatment and prognosis of hyponatremia in patients with different types of acute nerve injuries. Methods A total of 550 patients with acute nerve injury treated in our hospital were selected. The clinical data of the patients were collected. The patients were divided into traumatic brain injury (TBI) group, tumor group, subarachnoid hemorrhage (SAH) group and intraparenchymal hemorrhage (IPH) group according to the different primary diseases of the patients. The clinical and prognostic indicators were compared. The patients were divided into hyponatremia group and non-hyponatremia group. The clinical data of the patients in each group were compared. Results More than half of the patients (296/550, 53.8%) developed hyponatremia. Most hyponatremia patients (209/296, 70.6%) were mild. Compared with the tumor group and the IPH group, the incidence of hyponatremia in patients with SAH and TBI increased significantly (all P<0.05). A total of 34.2% (188/550) patients underwent blood sodium corrective therapy, and compared with the tumor group and the IPH group, the percentage of patients with SAH and TBI undergoing blood sodium corrective therapy improved significantly (all P<0.05). The most common treatment indications were the decrease in serum sodium (111/188, 59.0%), cerebral edema with mental state changes (34/188, 18.1%). For the patients underwent blood sodium corrective therapy (n=188), infusion of hypertonic saline (137/188, 72.9%) is the most common initial treatment for blood sodium corrective therapy,followed by oral sodium chloride (59/188,31.4%). The 62.2% of patients(117/188) with blood sodium corrective therapy responded to the blood sodium corrective therapy, and the highest increase in blood Na+ after intravenous infusion of hypertonic saline 24 h was (6.57±0.96) mmol/L. The second was fluid restriction (5.62±1.16) mmol/L and oral sodium chloride (3.51±0.90) mmol/L. The prognosis rate of hyponatremia group was significantly lower than that of non-hyponatremia group ［49.0% (145/296) vs. 59.1% (150/254), χ2=5.573, P=0.018］. The length of ICU hospitalization time［(8.58±1.86)d vs. (4.23±1.18)d, t=32.133, P<0.001］ and the total hospitalization time［(13.79±2.46)d vs. (7.33±1.30)d, t=37.587, P<0.001］ in the patients with hyponatremia were significantly higher than those in the non-hyponatremia group. Conclusion The incidence of hyponatremia is higher in patients with acute nerve injury and the patients with acute nerve injury usually undergo blood sodium corrective therapy. Infusion of hypertonic saline is a first-line treatment. Most patients had a positive response to treatment within 24 h.

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	Yang Liu
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Yang Liu,Zhang Min,He Xi, et al. The clinical characteristics and prognosis of patients with different types of acute nerve injury complicated with hyponatremia[J]. Chinese Journal of Critical Care Medicine, 2018, 38(2): 159-163.

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http://www.cnemergency.org.cn/EN/10.3969/j.issn.1002-1949.2018.02.014 OR http://www.cnemergency.org.cn/EN/Y2018/V38/I2/159

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