普通外科住院患者低钠血症的现状调查

Present situation research of hyponatremia in surgery

【目的】探讨普通外科发生重度低钠血症的常见病因、发病及诱发机制。【方法】回顾2005年5月-2007年6月我院普通外科住院患者,分为禁食组2 490例及非禁食组1 200例,对比两组血清钠、血渗透压、红细胞比积、低钠血症的临床表现、治疗特点差别。【结果】在禁食组低钠血症258例,原发性43例,继发性215例;重度低钠血症49例,其中术前7例,术后42例。非禁食组低钠血症47例,原发性7例,继发性40例;重度低钠血症19例,术前3例,术后16例。禁食组与非禁食组联合应用抗生素、大剂量补液、应用高糖、切口引流、胃肠减压,术前与术后比较有统计学差异(P<0.05),两组重度低钠血症发生率术后比较有统计学差异(P<0.05),原发性低钠血症发生率比较有统计学差异(P<0.05),禁食组与非禁食组的继发性低钠血症术前术后比较有统计学差异(P<0.05)。【结论】禁食患者继发性医源性重度低钠血症增多,术后低钠血症的患病率增加,与年龄、性别及所合并的疾病相关,与治疗时补液成份及方法相关。

【Objective】 Investigate the common etiological factors and mechanisms of hyponatremia in surgery.【Methods】 Reviewing all patients with in-patient in department of genral surgery from May,2005 to June,2006 were divided fasting into non-fasting groups,to observe level of serum sodium,plasma osmotic pressure,hematocrit and deference of clinical manisfestions and treatment in two groups.【Results】 There were 258 hyponatremia patients in fasting diet group including 43 primarily and 215 subsequent patients.Among these,there were 49 severe hyponatremia patients including 7 patients before surgery and 42 patients after surgery.Whereas,in non-fasting diet group there were 47 hyponatremia patients including 7 primarily and 40 subsequent patients.Correspondingly,there were 19 severe hyponatremia patients including 3 patients before surgery and 16 patients after surgery.Preoperative and postoperative statistics data was contrasted in the two groups,combining application antibiotic transfusion,high concentration sugar,incision elicitation,stomach-intestine decompression（P0.05）,the severe hyponatremia,primary hyponatremia and subsequent hyponatremia in the group of postoperative is more frequency than the other（P0.05）.【Conclusion】 There are much higher prevalence of severe subsequent iatrogenic hyponatremia especially after surgery,and there are correlations with age,sex and complicating diseases,as well as the components and methods in fluid replacement.