高钠血症对危重病预后的影响

目的探讨高钠血症对危重病患者预后的影响。方法对760例危重患者的生化检验结果进行调查,发现血钠≥150 mmol/L者67例,对其进行临床资料分析,并动态评估急性生理和慢性健康Ⅱ分值(APACHEⅡ)。结果最易发生高钠血症的疾病为中枢神经系统疾病、多发伤、败血症、糖尿病和重症肺炎。最常见的诱因为脱水剂治疗、高热、饮食及补液量不足、补钠过多、下丘脑受损。高钠血症患者的总病死率是非高钠血症的同期住院危重患者病死率的6.5倍。当血钠在150~159 mmol/L时,APACHEⅡ(25±5)分,病死率为34%;当血钠≥160 mmol/L时,APACHEⅡ(49±7)分,病死率为95%。结论高钠血症对危重病患者的预后有很大影响,主要取决于原发病、血钠绝对值和血钠上升速度。大多数高钠血症是医源性的,因而是可以预防或避免的。

Effect of hypernatremia on the prognosis of severe disease

Objective It is to explore the effect of hypernatremia on the prognosis of severe disease.Methods The result of biochemistry examination of 760 patients with severe disease was investigated,and 67 cases with hypernatremia were found.Then their clinical data was analyzed and Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ) was evaluated.Results Central nerve system disease,multiple injury,severe sepsis,diabetes mellitus and severe pneumonia were easily complicated with hypernatremia.The most commonly inducement were applying dehydrolyzing agent,high fever,insufficient diet or liquid,supplying excessive natrium and hypothalamus defect.The mortality of patients with hypernatremia was 6.5 times more than that without in hospital in the same period.The mortality was 34% when serum natrium was 150-159 mmol/L and APACHEII score was 25±5,while the mortality was 95% when serum narium ≥160 mmol/L and APACHE Ⅱ score was 49±7.Conclusions Hypernatremia has a great effect on the prognosis of patients with serve disease,which mainly relied on primary disease,absolute value of serum natrium and its increasing speed.Most of hypernatremia was iatrogenic,so it could be prevented and avoided.