急诊重症监护病房内高钠血症患者的临床分析

Clinical study on patients with hypernatremia in emergency intensive care unit

目的探讨急诊重症监护病房（EICU）高钠血症的发生率、病死率、临床特征及预后。方法回顾性分析2009年我院EICU收治所有患者的临床资料，对符合高钠血症诊断标准的患者，进一步分析临床特征及预后等。结果2009年度我院EICU共收治267例患者，其中18例发生高钠血症，其中有15例死亡，高钠血症的发病率和病死率分别为6．74％和83．3％，发生高钠血症时患者的APACHEII评分显著高于入院时的评分（P〈0．01）；死亡患者的平均生存天数与临终前高钠血症的治疗结局有明显的相关性，持续高钠的患者平均生存天数仅为3．8d，明显低于血钠纠正患者的19．6d。分析结果提示，高钠血症发生的原因主要包括大量使用碳酸氢钠溶液及限制液体的自由摄人等。结论高钠血症是EICU的常见并发症，死亡率较高；医源性因素是发生高钠血症的重要原因之一；高钠血症对疾病的转归有不利影响，应尽量避免导致高钠血症的诱发因素，采取积极措施纠正和控制高钠血症。

Objective To determine the incidence, clinical characteristics, and the prognosis of patients with hypernatremia in the emergency intensive care unit. Methods Retrospective cohort study was deployed on the clinical data bank of patients admitted to EICU of our hospital in 2009. All those patients whose biochemical indicators matched the hypernatremia diagnosis were selected for further study of clinical pathogenesis and prognosis. Results There were 267 patients admitted to EICU in 2009, among which 18 patients were diagnosed as hypernatremia, including 15 patients＇ death report. The mobidity and motality of hypernatremia was 6.74% and 83.3% respectively. The Apache II score was significantly higher on the day of the hypernatremia diagnosis than the admission day（P 〈0.01 ）. The patients＇ life span has strong relationship with the outcome of the treatment on hypernatremia. The mean life span was significantly shorter in patients with the uncontrollable hypernatremia than those with curable hypernatremia （3.8 days vs 19.6 days ）. The analysis of clinical materials shows that the occurrence of hypernatremia was attributed to the abuse of sodium bicarbonate and the restriction of water intake. Conclusion Hypernatremia is one of the commonest complications in the EICU and leads to the high motality. Iatrogenic factor plays an important role in the genesis of hypernatremia which causes severe side effects to the disease turnover. We should put more emphasis on the prophylaxis and treatment of hypernatremia.