摘要
目的：探讨重症脑损伤急性期钠代谢失衡特点与伤情及预后关系。方法：分析１９９５年６月～１９９７年６月资料完整的格拉斯哥昏迷评分（ＧＣＳ）≤８分的２８４例脑损伤患者血清钠变化情况，将伤后２４小时、７２小时及１周后的血清钠失衡的发生频率及性质进行对比分析，并对直接影响预后的高钠血症患者进行伤情特点分析。结果：重症脑损伤急性期钠代谢失衡主要是低钠血症，其伤后２４小时、７２小时及１周的发生率分别是５１．８％，５３．５％和４８．６％，差异无显著性（Ｐ＞０．０５）；同期高钠血症的发生率分别为１．０％，４．９％和９．５％，伤后１周后高钠血症发生率较伤后２４小时内增高，差异有显著性（Ｐ＜０．０５）。低钠血症发生率虽高但容易被纠正，对预后不产生明显影响；高钠血症发生率虽低，但临床纠正困难，伤后１周后出现高钠血症者病死率为８１．５％（２２／２７），与本组其他患者病死率３４．６％（８９／２５７）有明显差异（χ２＝２５．６，Ｐ＜０．０１）。结论：重症脑损伤急性期钠代谢失衡与脑损伤本身病理机制有关；
Objective:To investigate the character of the sodium metabolism imbalance and its relationship with the prognosis in severe cerebral lesion.Methods:Serum sodium levels were determined in 284 cases with cerebral lesion,graded less than 8 points by Glasgow coma scale(GCS) admitted,from June 1995 to June 1997.We analyzed the frequency and the character of the serum sodium imbalance at 24,72 hours and in one week after cerebral lesion,and observed whether hypernatremia would affect the prognosis or not.Results:The major sodium metabolism imbalance in the acute severe cerebral lesion was hyponatremia,and the incidence rate of which was 51 8% (147/284),53 5%(152/284),and 48 6% (138/284) at 24,72 hours and in one week respectively ( P >0 05).At the same time,the incidence rate of hypernatremia was 1 0% (3/284),4 9% (14/284) ,and 9 5%(27/284) respectively,and it was much higher in one week than that at 24 hours after the onset of the disease ( P <0 05).Though the incidence rate of hyponatremia was common,it was easy to correct and would notaffect the prognosis.However,although the incidence rate of hypernatremia was much lower but it was difficult to treat,and mortality of hypernatremia was 81 5%(22/27) in one week after the onset of the cerebral lesion,being much higher than patients without hypernatremia (34 6%,89/257).Conclusions:The sodium metabolism imbalance appears to be associated with the development of acute severe cerebral lesion.Continuous hypernatremia in one week after the onset of the cerebral lesion is the risk factor leading to fatal outcome.
出处
《中国危重病急救医学》
CAS
CSCD
1999年第3期158-160,共3页
Chinese Critical Care Medicine
基金
浙江省萧山市科协科研基金
关键词
脑损伤
钠代谢
高钠血症
预后
cerebral lesion\ \ sodium metabolism\ \ hypernatremia\ \ prognosis
