重症脑卒中后高钠血症的发生及其临床特点分析

目的:研究重症脑卒中患者并发高钠血症的发生率及其临床特点,为制定干预措施提供依据。方法:回顾性分析156例急性重症脑卒中患者的临床资料和临床转归,观察其发病24h内、>24~72h、>72h~1周内高钠血症的发生率及高钠血症与卒中类型、病灶部位、病情轻重和临床转归的相关性。结果:出现高钠血症25例。发病后72h内发生者16例,其中2例为重症高钠血症;72h后高钠血症9例,其中重症高钠血症5例。72h内的高钠血症与医源性因素有关,>72h~1周时血钠大多为中重度升高,与脑损害严重相关。高钠血症与卒中类型无明显关系(P>0.05),与卒中部位(以脑干、丘脑、小脑卒中高钠血症为多发)、病情轻重和预后均有一定关系(P<0.05~P<0.01)。结论:医源性因素和脑干、丘脑、小脑损害是引起重症脑卒中后高钠血症的主要原因,高钠血症可作为判断病情和估计预后的重要指标。

Study on the incident and clinical features of hypernatremia in severe stroke

Objective：To study the incidence rate and clinical features of hypernatremia in severe stroke and provide the evidences for therapy.Methods：The clinical data and clinical prognosis of 156 admitted patients with severe stroke were analyzed retrospectively.The incidence rate of hypernatremia in 24 hours,〉24 to 72 hours and 〉72 hours to 1 week were analyzed.The relationships between hypernatremia and the types of stroke,focus places,the neurological deficit and clinical prognosis were also analyzed.Results：Among all patients 25 patients were accompanied with hypernatremia,the incidence rate of hypernatremia was 16.03%.Sixteen patients with hypernatremia were happened in 72 hours after stroke,and 2 patients were accompanied with severe hypernatremia.And the iatrogenic factor maybe was the main risk factor.Nine patients with hypernatremia were happened after 72 hours,of which 5 patients were accompanied with severe hypernatremia.Hypernatremia had the relationship with focus places ofstroke（especially in brainstem,thalamus and cerebellum）,the neurological deficit and prognosis（P〈0.05-P〈0.01）,and had no relationship with types of stroke（P〉0.05）.Conclusions：The iatrogenic factor and the injury on brainstem,thalamus and cerebellum are the reasons for hypernatremia after stroke.The emergence of hypernatremia is considered as an important index which estimates the state of stroke and clinic prognosis.