脑卒中患者高渗状态的危险因素研究

Risk factors for hyperosmolar state in stroke patients

目的探讨脑卒中患者高渗状态的危险因素。方法收集脑卒中合并高渗状态患者32例做为高渗状态组，抽取同期非高渗状态的脑卒中患者63例为对照组。采用Logistic回归分析确定脑卒中患者高渗状态的危险因素。结果高渗状态组平均血浆渗透压[（338．8_＋12．5）mOsm／L]明显高于对照组[（285．7±11．7）mOsm／L]，高渗状态组平均GCS分值[（6．9±2．7）分）]明显低于对照组[（12．7±3．5）分]，差异均有统计学意义（P〈0．05）。多因素Logistic回归分析证实，糖尿病（OR=0．043，95％CI=0．007～0．277，P=-0．001）、全身炎症反应综合征（SIRS）（OR=0．550，95％CI=0．388--0．780，P=0．001）、甘露醇用量（OR=0．973，95％CI=0．955～0．991，P=-0．004）是脑卒中患者高渗状态的危险因素。结论糖尿病、SIRS、甘露醇用量可以联合或单独作用引起高渗状态．治疗过程中重视这三项指标的监测将有助于卒中患者的康复。

Objective To study the risk factors for hyperosmolar state in stroke patients. Methods The clinical data of 32 stroke patients with hyperosmolar state （HS group） and 63 randomly selected stroke patients without hyperosmolar state （control group） were analyzed. The hyperosmolar state was defined as the plasma osmotic pressure 〉320 mOsm/L, and logistic regression was performed to identify the risk factors for hyperosmolar state in the stroke patients. Results The mean plasma osmotic pressure in the HS group was significantly higher than that in the control group （338.8±12.5 vs 285.7±11.7 mOsm/L, P〈0.05）. The stroke patients with hyperosmolar state had a significantly lower mean Glasgow Coma Score than the control patients （6.9±2.7 vs 12.7±3.5, P〈0.05）. Multiple logistic regression analysis showed that diabetes （OR=0.043, 95% CI=0.007-0.277, P=-0.001）, systemic inflammatory response syndrome （SIRS） （OR=0.550, 95%CI=0.388-0.780, P=-0.001）, and the daily dose of mannitol （OR=0.973, 95%CI=0.955-0.991, P=-0.004） were the risk factors for hyperosmolar state in stroke patients. Conclusion Diabetes, SIRS and the daily mannitol dose are the risk factors for hypreosmolar state in stroke patients, and by acting jointly or separately, these risk factors are responsible for the onset ofhypreosmolar state.