完全性颈脊髓损伤患者早期发生低钠血症的多因素分析

Multivariate Analysis for Early Stage Hyponatremia in Patients with Complete Cervical Spinal Cord Injury

目的探讨导致急性完全性颈脊髓损伤患者早期出现低钠血症的相关因素。方法回顾性分析2010年1月~2015年12月完全性颈脊髓损伤患者49例临床资料。以连续2次(间隔<24 h)血钠<135 mmol/L为低钠血症的诊断标准,合并低钠血症的26例为低钠血症组,未合并低钠血症的23例为对照组。对年龄,性别,颈脊髓损伤最高节段、损伤程度,是否使用糖皮质激素治疗,是否合并神经源性休克,平均每日尿量,平均每日液体平衡量,转入危重医学科时血钠水平和血浆白蛋白水平共10项指标进行单因素分析,单因素分析有统计学意义(P<0.05)的指标再进行logistic逐步回归分析。计量资料单因素分析有统计学意义的指标通过绘制ROC曲线确定其最佳临界点。结果单因素分析中,2项指标在2组间有统计学差异(P<0.05),低钠血症组患者低钠血症发生前神经源性休克发生率为57.7%(15/26),对照组为26.1%(6/23)(χ~2=6.516,P=0.011);低钠血症组患者平均每日尿量(2225±389)ml,对照组(1936±289)ml(t=2.924,P=0.005)。logistic逐步回归分析显示这两项因素均为完全性颈脊髓损伤患者早期发生低钠血症的独立影响因素(OR=13.708、0.996,P=0.004、0.002)。ROC曲线显示平均每日尿量的最佳临界点为2331 ml。结论并发神经源性休克与平均每日尿量>2331 ml为完全性颈脊髓损伤患者早期发生低钠血症的独立影响因素。

Objective To investigate the relevant factors of early stage hyponatremia in patients with complete cervical spinal cord injury（ CSCI）. Methods A retrospective study was conducted in consecutive 49 individuals with complete CSCI from January2010 to December 2015. The diagnostic criteria for hyponatremia was two consecutive tests（ interval 24 h） of serum sodium 135 mmol / L. Twenty-six patients with hyponatremia were classified as hyponatremia group,and the other 23 patients without hyponatremia were classified as control group. Ten factors were included in the univariate analysis： age,gender,the highest level of CSCI,the degree of CSCI,the blood albumin when transferred to ICU,the serum sodium when transferred to ICU,the use of glucocorticoid,the incidence of neurogenic shock,the average daily urine output,and the average daily liquid balance. The variables with significance（ P〈0. 05） in the univariate analysis then entered stepwise logistic regression analysis. The optimal critical point of the continuous variables with statistical significance in the univariate analysis was determined by drawing the receiver operator characteristic curve.Results There were differences in two variables between the two groups（ P〈0. 05）. The incidence of neurogenic shock before the occurrence of hyponatremia was 57. 7%（ 15 /26） in the patients with hyponatremia and 26. 1%（ 6 /23） in the patients without hyponatremia（ χ~2= 6. 516,P = 0. 011）. The average daily urine output was（ 2225 ± 389） ml in the patients with hyponatremia and（ 1936 ± 289） ml in the patients without hyponatremia（ t = 2. 924,P = 0. 005）. The stepwise logistic regression analysis indicated that these two factors may be the independent relevant factors（ OR = 13. 708 and 0. 996,P = 0. 004 and 0. 002,respectively）. The receiver operator characteristic curve demonstrated the average daily urine output more than 2331 ml was the optimal critical point.Conclusion The neurogenic shock and the average daily urine volume more than 2331 ml are the independent relevant factors of early stage hyponatremia in patients with complete CSCI.