高钠血症与颅脑损伤患者死亡相关风险研究

Severe hypernatremia is a risk factor for mortality in patients with traumatic brain injury

目的探讨不同程度高钠血症与颅脑损伤患者死亡的相关风险.方法将近5年ICU的颅脑损伤患者431例根据血钠水平分为4组,非高钠组（〈150mmol/L）、轻度高钠组（150~155mmol/L）、中度高钠组（155~160 mmol/L）、重度高钠组（≥160mmol/L）,分析血钠水平与患者死亡的相关风险.结果重度高钠组患者的Glasgow昏迷评分（GCS）3.27±0.89,APACHE-II评分35.25±6.01,病死率93.82%,与轻、中度高钠组患者相比,具有统计学差异（P〈0.05）.Logistic多因素分析提示GCS评分下降（OR=3.96,95%CI=1.43~10.96,P〈0.05）,APACHE-II评分升高（OR=1.32,95%CI=1.21~1.41,P〈0.05）和重度高钠血症（OR=6.07,95%CI=3.19~13.87,P〈0.05）是颅脑损伤患者的死亡危险因素.结论重度高钠血症是脑外伤患者死亡的主要危险因素之一.

Objective To investigate the relationship between hypernatremia and the mortality risk for patients with trau-matic brain injury （TBI）. Methods Fours hundred and thirty one patients with TBI were enrolled in the study. Based on blood serum sodium level patients were divided into four groups：noon-hypernatremia （serum sodium〈150mmol/L）, mild hypernatrem-ia （serum sodium：150~155mmol/L）, moderate hypernatremia （serum sodium： 155~160mmol/L） and severe hypernatremia （serum sodium≥160mmol/L）. The risk of mortality with the serum sodium levels was analyzed. Results Severe hypernatremia groups had the lowest Glasgow Coma Scale （3.27±0.89） and the highest APACHE-II Scale （35.25±6.01） with a mortality rate of 93.82%. Logistic regression multivariable analysis showed that the decreased Glasgow Coma Scale （OR=3.96, 95%CI=1.43~10.96, P〈0.05）, increased APACHE-II Scale （OR=1.32, 95%CI=1.2~1.41, P〈0.05） and severe hypernatremia （OR=6.07, 95%CI=3.19~13.87, P〈0.05） were major risk factors for mortality of TBI patients. Conclusion Severe hypernatremia is a major risk factor for mortality of patients with traumatic brain injury.