缺血性卒中并发高钠血症危险因素的分析

目的探讨缺血性卒中患者并发高钠血症的危险因素，为早期干预提供依据。方法回顾性分析连续入院的缺血性卒中患者322例的临床资料。患者入院后1h内采用离子电极法测量血液生化指标。其中高钠血症43例，非高钠血症279例，记录可能影响血钠水平的9项危险因素，进行X^2或t检验，并采用多元Logistic回归分析，筛选出独立的危险因素。终点指标以发病后4周的病死率作为判断。结果缺血性卒中患者并发高钠血症危险因素的多因素分析显示，使用大剂量甘露醇（OR=4．9，95％ CI：2．40-9．71）、大脑中线结构损害（OR=3．9，95％ CI：2．00～7．65）、血糖增高（OR=1．4，95％CI：1．18～1．69）3项因素进入模型（P〈0．05）。高钠血症组4周病死率为67．4％（29／43），明显高于非高钠血症组的17．2％（48／279），两组比较差异有统计学意义（X^2=51．68，P〈0．01）。结论引起高钠血症的主要危险因素是大剂量甘露醇、大脑中线损害和血糖增高。高钠血症患者预后差，生存率低。

Ischemic stroke complicated with hypernatremia: an analysis of risk factors

Objective To explore the risk factors in patients with ischemic stroke complicated with hypernatremia for providing evidence for early intervention. Methods The clinical data of 322 consecutively admitted patients with ischemie stroke were analyzed retrospectively. Their blood biochemical indices were measured by the ion electrode method within one hour after admission. Among them, 43 patients had hypernatremia, and 279 patients had not. Nine risk factors that might influence serum sodium levels were examined by chi-square or t test, and the independent risk factors were screened using multiple Logistic regression analysis. The outcome indices were predicted with the mortality four weeks after the onset. Results The multivariate analysis of risk factors in patients with ischemic stroke complicated with hypernatremia showed that 3 factors including high-dose mannitol administration （ OR = 4. 9, 95% CI 2.40 - 9. 71 ）, midline brain lesion （ OR = 3.9, 95% CI 2. 00 - 7.65 ）, and hyperglycemia （ OR = 1.4, 95% CI 1.18 - 1.69 ） had entered into the model （P 〈 0.05 ）. The 4-week mortality was 67. 4% （29/43） in the hypernatremia group, which was significantly higher than 17. 2% （48/279） in the normal natremia group, and the difference was statistically significant between the 2 groups （X^2 = 51.68, P 〈 0. 01 ）. Conclusion The main risk factors resulting in hypernatremia were high-dose mannitol administration, midline brain lesion, and raised blood sugar. Patients with hyperuatremia had a poor prognosis and low survival rate.