监护病房中高血钠并发症发生的危险因素及预后分析

Prognosis and risk factors for hypernatremia in intensive care unit

目的 :确定高血钠对危重患者病死率的影响及发生高血钠并发症的危险因素。方法 :用急性生理功能与慢性健康状况评分 (APACHE )评分系统对入科诊断及疾病严重程度不同的患者进行合理分层 ,并在患者基础疾病严重程度和年龄基本一致的情况下比较和分析有高血钠患者和无高血钠患者的病死率 ,同时用单因素χ2 检验和多因素 logistic回归分析筛选和判定发生高血钠的危险因素。结果 :高血钠并发症在监护患者中有较高的发生率 (16 .5 5 % )。在相同条件下 ,高血钠患者比非高血钠患者病死率更高。高血钠并发症的发生主要与患者有不同程度的意识障碍或昏迷、多尿、高热、基础疾病较严重、经口饮水受限及使用脱水剂不当等因素显著相关。结论 :高血钠是监护病室常见并发症 ,且对疾病转归有不利影响 ,应重视并针对其危险因素加以预防。

Objective:To investigate the effect of hypernatremia on the mortality of critically ill patients and to determine risk factors associated with hypernatremia.Methods:The patients with various diagnosis and different severity of diseases were classified by acute physiology and chronic health evaluationⅡ (APACHEⅡ)score,and then the mortality of patients with hypernatremia were compared with that of controls without hypernatremia matched in underlying diseases and ages.The potential risk factors associated with hypernatremia were defined by univariate analysis and logistic regression analysis.Results:The incidence of hypernatremia in patients in ICU was high (16 55%).The actual mortality of the patients with hypernatremia was higher than that of patients without hypernatremia under matching conditions.By univariate analysis and logistic regression analysis,main risk factors for hypernatremia were found to be strongly associated with impaired mental status or coma,polyuria,hyperpyrexia,higher APACHEⅡ score,restricted free water intake by mouth and administration of osmotic diuretic improperly.Conclusions:Hypernatremia appears to be account for a poor outcome of critically ill patients.In patients with high risks for hypernatremia,more attention should be paid to prevent its development.