颅脑损伤后并发低钠血症情况、临床特点及危险因素分析

Condition, Clinical Characteristics and Risk Factors of Hyponatremia After Craniocerebral Injury

目的探讨颅脑损伤后并发低钠血症情况、临床特点及危险因素。方法回顾性分析我院2014年1月-2016年12月收治的颅脑损伤后并发低钠血症及单纯颅脑损伤患者784例的临床资料,统计颅脑损伤后并发低钠血症情况及总结其临床特点,并通过多因素Logistic回归分析寻找颅脑损伤后并发低钠血症的危险因素。结果784例颅脑损伤患者中伤后并发低钠血症300例,发生率为38.27%,低钠血症发生时间为伤后1~42(6.16±1.04)d。300例颅脑损伤后并发低钠血症患者年龄17~53岁,其中≥40岁者199例(66.33%);损伤程度以中重度者居多[245例(81.67%)],合并脑水肿者167例(55.67%);临床表现以头痛加剧和(或)意识障碍加深为主。多因素Logistic回归分析显示:年龄≥40岁、中重度颅脑损伤、蛛网膜下腔出血、合并脑水肿是颅脑损伤后并发低钠血症的独立危险因素(P<0.05或P<0.01)。结论颅脑损伤后并发低钠血症发生率较高,发生时间多为伤后1个月左右,损伤程度常较严重,且合并脑水肿者较多,常见临床表现为头痛加剧和(或)意识障碍加深;年龄≥40岁、中重度颅脑损伤、蛛网膜下腔出血、合并脑水肿是颅脑损伤后并发低钠血症的独立危险因素。

Objective To explore the condition,clinical characteristics and risk factors of hyponatremia after craniocerebral injury(CCI).Methods The clinical data of 784 patients with hyponatremia after CCI and simple craniocerebral injury who were admitted in our hospital from January 2014 to December 2016 were retrospectively reviewed.The incidence and clinical characteristics of hyponatremia after CCI were summarized,and multivariate logistic regression analysis was used to pinpoint the risk factors of hyponatremia after CCI.Results Of 784 patients with CCI,300 patients developed hyponatremia,and the incidence was 38.27%.The onset time of hyponatremia was at 1-42 d after CCI,with an average of(6.16±1.04)d.The age of 300 patients with hyponatremia was 17-53 years,among which 199 patients(66.33%)were over 40 years.Most of them[245 cases(81.67%)]had moderate and severe CCI and 167 patients(55.67%)were complicated with brain edema.The main clinical manifestations were headache aggravation and/or aggravated disturbance of consciousness.Multivariate logistic regression analysis showed that age≥40 years,moderate and severe CCI,subarachnoid hemorrhage(SAH),and brain edema were independent risk factors of hyponatremia after CCI(P<0.05 or P<0.01).Conclusion The incidence of hyponatremia after CCI is relatively high,the time of occurrence is about 1 month after CCI,the degree of injury is often serious,and many patients have CCI combined brain edema.The common clinical manifestations are headache aggravation and aggravated disturbance of consciousness.Age≥40 years,moderate and severe CCI,SAH and brain edema are the independent risk factors of hyponatremia after CCI.