摘要
目的探讨干预重症卒中并发高渗血症患者的临床价值。方法选择并发高渗血症的重症卒中患者[入院时格拉斯哥昏迷评分(GCS)≤12分]34例,通过控制补液量、利尿药和血糖,动态观察干预前后血浆渗透压及其相关因素的变化,评价干预治疗对预后的影响。结果控制补液量是高渗血症最常用(85.3%)的干预措施,其次为控制渗透性利尿药用量(41.2%)和控制血糖(41.2%)。干预前血浆渗透压(321±10)mmol/L,血钠(146±5)mmol/L,血糖(9.5±2.8)mmol/L;干预后分别为(308±18)、(142±7)和(7.5±3.1)mmol/L。血浆渗透压降至正常者住院期病死率为15.8%,明显低于血浆渗透压未降至正常者的病死率(100%),差异有显著性(P<0.01)。多因素Logistic回归分析显示,影响住院患者病死率的主要危险因素是血浆渗透压增高和APACHE(acutephysiologyandchronichealthevaluation)Ⅱ评分增高。结论降低血浆渗透压可改善重症卒中并发高渗血症患者的预后,降低住院病死率。
Objective To explore the clinical value in the intervention of patients with severe stroke complicated with plasma hyperosmolality. Methods Thirty-four patients with severe stroke （Glasgow coma score [ GCS]≤ 12 on admission）, who complicated with plasma hyperosmolality were selected. The changes of plasma osmotic pressure before and after the intervention and its related factors, as well as the effect of interventional therapy on prognosis were observed dynamically by controlling fluid replacement, diuretic, and blood sugar. Results The most common interventional measures for plasma hyperosmolality were to control the fluid replacement （85.3%）, the secondly to control the dosage of os- motic diuretic （41.2%） and blood glucose level （41.2%）. Before the intervention, plasma osmotic pressure, natrium intaking and blood glucose level were （321 ± 10） , （ 146 ±5 ） , and （9.5 ± 2. 8 ） mmol/L, respectively; after the intervention, they were reduced to （308 ± 18）, （142 ± 7）, and （7. 5 ± 3.1 ） mmoL/L, respectively. The in-hospital mortality in patients who were intervened successfully （plasma osmotic pressure reduced to normal levels） in hyperosmolality group was 15.8%, and it was significantly lower （ P 〈 0. 01 ） than that in patients （ 100% ） who were intervened unsuccessfully （ plasma osmotic pressure did not reduced to normal levels）. Muhifactor logistic regression analysis showed that the major risk factors that influenced the in-hospital mortality were the increase of plasma osmotic pressure, and the increase of acute physiology and chronic health evaluation Ⅱ （ APACHE Ⅱ ） scores. Conclusion Reducing the plasma osmotic pressure may improve the prognosis in patients with severe stroke complicated with plasma hyperosmolality, and reduce the in-hospital mortality.
出处
《中国脑血管病杂志》
CAS
2006年第5期219-222,共4页
Chinese Journal of Cerebrovascular Diseases
关键词
卒中
干预性研究
高渗血症
Stroke
Interventional study
Plasma hyperosmolality
