高龄低钠血症患者的临床特点及防治

Clinical characteristics of hyponatremia and related treatment in the very old patients

目的 探讨高龄低钠血症患者的临床特点及发生原因,为临床防治低钠血症提供理论依据。方法 选择我院老年科住院的80岁以上低钠血症患者(高龄低钠组)33例,分别对其临床特点进行逐项统计,并对其中25例患者进行24 h尿钠排泄量测定。同时选择80岁以上非低钠血症患者(高龄对照组)34例及60-79岁非低钠血症患者(老年对照组)31例同样测定24 h尿钠排泄量作为对照。结果 (1)高龄低钠组患者患冠心病、高血压病及糖尿病的比率高,可能是肾动脉硬化而保钠及保钾能力减退和尿钠排泄增多的原因之一;(2)钠盐摄入不足及高渗混合奶使体内钠过多消耗是导致部分高龄患者发生低钠血症的重要原因之一;(3)大量出汗也是导致低钠血症的原因之一;(4)利尿剂的应用是导致高龄患者发生低钠血症的原因之一。结论 高龄低钠组患者是多因素的综合结果。对不能自由进食的高龄患者应保证足够的钠盐摄入,对有发热多汗及应用利尿剂的患者应适当增加钠盐摄入。

Objective To study the characteristics and the causative factors of hyponatremia in the very old patients in order to provide theoretical basis for treatment and prevention of hyponatremia. Methods Clinical characteristics of 33 patients over 80 years old with hyponatremia in our geriatric department were investigated. 24 hour urinary sodium excretion was examined in 25 hyponatremia patients, 34 patients aged over 80 and 31 patients aged 60 ~ 79 without hyponatremia. Results Proportion of hyponatremia patients suffering from coronary heart disease, hypertension and diabetes mellitus was very high, which might be the cause of arteriosclerosis of the renal artery and increase in the urinary sodium excretion. Decrease in sodium intake, excessive consumption of sodium due to tube feeding might be one of the causes of hyponatremia. Excessive sweating and the use of diuretics might also be the causes of hyponatremia. Conclusion Multifactor could contribute to hyponatremia of the very old patients. Enough sodium should be given to the patients on tube feeding, with excessive sweating and treated with diuretics.