神经外科重症患者高钠血症与急性肾损伤的关系

Association of hypernatremia and acute kidney injury in severe neurosurgical patients

目的探讨神经外科重症患者高钠血症与急性肾损伤(AKI)发生的关系。方法 ICU神经外科重症患者104例,住院期间发生AKI患者27例(观察组),未发生AKI患者77例(对照组),比较两组入ICU后0、24、48和72h血钠水平,统计病情和治疗相关资料,分析AKI发生的相关影响因素。结果观察组入ICU后各时间点的血钠水平均高于对照组(P<0.01);观察组入ICU 72h内高钠血症发生率40.7%(11/27),高于对照组的19.5%(15/77)(P<0.05)。Logistic回归分析显示,影响AKI发生的密切相关因素包括年龄、头部手术率、甘露醇应用总量、呼吸机应用时间和住院期间高钠血症发生情况(P<0.01)。结论高钠血症与AKI的发生密切相关,控制神经外科重症患者血钠水平有助于预防AKI。

Objective To investigate the association of hypernatremia and acute kidney injury（AKI）in severe neurosurgical patients.Methods A total of 104 severe neurosurgical patients in ICU was assigned into two groups of A（with AKI during ICU stay）and B（without AKI）.Serum levels of sodium at 0,24,48 and 72 hours during ICU stay were compared between two groups.The data related to illness and treatments were collected.The factors associated with the occurrence of AKI were analyzed.Results Serum levels of sodium during ICU stay were higher in group A than those in group B（P〈0.01）.The incidence rate of hypernatremia was 40.7%（11/27）in group A,which was higher than 19.5%（15/77）in group B（P〈0.05）.Logistic regression analysis showed that the age,percentage of head surgery,total amount of mannitol infusion,mechanical ventilation time and hypernatremia were the fectors closely related to the occurrence of AKI（P〈0.01）.Conclusion The hypernatremia is closely related to the occurrence of AKI and well controlling blood sodium level is helpful in preventing AKI in the severe neurosurgical patients.