中重度创伤性脑损伤患者并发低钾血症危险因素分析

Risk factors of hypokalemia in patients with moderate to severe traumatic brain injury

目的分析中重度创伤性脑损伤(TBI)患者并发低钾血症的危险因素。方法选择2016年1月-2018年12月宁夏回族自治区人民医院神经外科出院的中重度TBI患者216例,根据住院期间血钾值是否低于3.5 mmol/L分为低钾血症组和血钾正常组,对2组患者资料进行单因素及多因素Logistic回归分析。结果单因素分析显示:低钾血症组患者年龄≥60岁、糖尿病、急性硬膜外血肿、创伤严重程度评分(ISS)>16分、GCS评分≤8分、呋塞米、甘露醇、胰岛素、发热、禁食、导泻、亚低温治疗占比高于血钾正常组,差异均有统计学意义(P<0.05)。Logistic回归分析结果显示:年龄≥60岁(OR=2.631,95%CI 1.208~5.729)、GCS评分≤8分(OR=2.571,95%CI 1.103~5.996)、甘露醇(OR=2.753,95%CI 1.433~5.287)、禁食(OR=3.545,95%CI 1.852~6.786)、亚低温治疗(OR=5.292,95%CI 1.941~14.429)是中重度TBI并发低钾血症的独立危险因素。该回归方程对中重度TBI并发低钾血症的预测正确率为73.1%。结论中重度TBI患者低钾血症发生率较高,年龄≥60岁、GCS评分≤8分、甘露醇、禁食、亚低温治疗是中重度TBI并发低钾血症的独立危险因素。对具有危险因素的中重度TBI患者应尽早进行医疗及护理干预,降低低钾血症发生率,减轻低钾血症对患者造成的危害。

Objective To analyze the risk factors of hypokalemia in patients with moderate to severe traumatic brain injury(TBI).Methods 216 patients with moderate to severe TBI were discharged from department of neurosurgery,the People’s Hospital of Ningxia Hui Autonomous Region from January 2016 to December 2018 were selected,according to whether the blood potassium value is lower than 3.5 mmol/L during hospitalization,they were divided into hypokalemia group and normal serum potassium group,the independent risk factors were determined by univariate analysis and Logistic stepwise regression analysis of the data of the two groups.Results The results of single factor analysis showed that:the proportion of age≥60 years,diabetes,acute epidural hematoma,trauma severity score(ISS)>16 points,GCS≤8 points,furosemide,mannitol,insulin,fever,fasting,catharsis,mild hypothermia treatment in hypokalemia group was higher than that in the normal serum potassium group,and the differences were statistically significant(P<0.05).Logistic stepwise regression analysis show that:age≥60 years old(OR=2.631,95%CI 1.208~5.729),GCS score≤8 points(OR=2.571,95%CI 1.103~5.996),Mannite(OR=2.753,95%CI 1.433~5.287),Fasting(OR=3.545,95%CI 1.852~6.786),Mild hypothermia treatment(OR=5.292,95%CI 1.941~14.429)were independent risks factor for hypokalemia in moderate to severe TBI patients.The accuracy of Logistic regression equation in predicting moderate to severe TBI complicated with hypokalemia was 73.1%.Conclusion The actual incidence of hypokalemia in moderate to severe TBI patients was higher,age≥60 years old,GCS score≤8 points,Mannitol,Fasting,Mild hypothermia treatment are independent risk factors for hypokalemia in TBI patients.Moderate to severe TBI patients with the above factors should be given medical treatment and nursing intervention as soon as possible,so as to reduce the incidence of hypokalemia and the harm caused by hypokalemia to moderate to severe TBI patients.