围术期血清钠离子水平对重型颅脑损伤患者病情及预后的影响

The effect of perioperative serum sodium levels on the condition and prognosis in severe craniocerebral injury patients

目的研究重型颅脑损伤患者血钠紊乱的情况以及血钠在重型颅脑损伤病情及预后评估的临床应用价值。方法以我院98例重型颅脑损伤患者为研究对象,结合患者GCS评分观察其血钠检测情况,并研究患者预后与血钠紊乱的关系。结果重型组与特重型组血钠紊乱发生率、低钠血症发生率以及高钠血症发生率差异均有统计学意义(P<0.05),均以特重型组发生率较高;2组低钠血症以及高钠血症血钠平均血清水平比较差异有统计学意义(P<0.05),低钠血症以特重型组血钠平均水平较低,高钠血症以特重型组血钠平均水平较高。2组总病死率、低钠血症病死率及高钠血症病死率差异均有统计学意义(P<0.05),均以特重型组发生率较高;血钠正常颅脑损伤患者病死率11.1%,低钠血症颅脑损伤患者病死率32.0%,高钠血症颅脑损伤患者病死率48.6%;差异均有统计学意义(P<0.05),以高钠血症颅脑损伤患者病死率较高。结论血钠代谢紊乱程度可反映重型颅脑损伤患者病情的严重性并与患者预后关系密切,血钠紊乱程度越高往往预示着患者预后越差。

Objective To study state of serum sodium disturbance and the clinical application value of serum sodium levels in condition and prognosis assessment in severe craniocerebral injury patients.Methods 98 cases with severe craniocerebral in‐jury in our hospital were selected as the research objects ,we detected the serum sodium levels combination with the GCS scores and studied the relationship between the prognosis and serum sodium disorders.Results The incidence rates of serum sodium disorder ,hyponatremia and hypernatremia disclosed statistical differences between severe group and particularly severe group （P〈0.05） with higher incidence in particularly severe group. Serum sodium levels also had statistically significant difference in two groups with hyponatremia and hypernatremia （P〈0.05） ,patients with hyponatremia had lower serum sodium level and hypernatremia had higher serum sodium level in particularly severe group;The total mortality ,hyponatremia mortality and hy‐pernatremia mortality in particularly severe group were significantly higher than that in severe group （P〈0.05）. The mortality of craniocerebral injury patients with normal serum sodium level ,with hyponatremia and with hypernatremia were 11.1% , 32% and 48.6% ,and there was significant difference in three above‐mentioned different levels of serum sodium （P〈0.05） , and patients with hypernatremia had the higher mortality.Conclusion The degree of blood sodium disorders can reflect the se‐verity of severe craniocerebral injury and close relationship with prognosis ,the higher level the blood sodium disorder has ,the poorer prognosis it predicted.