颅脑外伤后并发低钠血症的危险因素分析

Risk factors analysis of hyponatremia after traumatic brain injury

目的探讨颅脑外伤患者并发低钠血症的发生机制及危险因素,以期为其早期预测及预防提供参考。方法回顾性分析2016年6月至2019年6月我院收治的185例中型和重型颅脑外伤患者的临床资料,包括导致低钠血症的不同病因、损伤类型、性别、格拉斯哥昏迷(GCS)评分、手术、脑水肿、颅底骨折和穿透性性损伤等;采用单因素χ^2检验和多因素Logistic回归分析探究颅脑外伤后并发低钠血症的危险因素。结果所有患者中,80例出现低钠血症,其中钠盐摄入不足、利尿剂过量使用47例,抗利尿激素分泌失调综合征19例,脑性耗盐综合征14例。低钠血症更多发生在脑挫裂伤、蛛网膜下腔出血和弥漫性轴索损伤患者中,差异具有统计学意义(P<0.05)。单因素χ^2检验结果显示,GCS评分(P=0.000)、脑水肿(P=0.000)、颅底骨折(P=0.000)、穿透性损伤(P=0.001)是颅脑外伤后并发低钠血症的相关因素。多因素Logistic回归分析结果显示,GCS评分(P=0.006)、脑水肿(P=0.006)、颅底骨折(P=0.000)、穿透性损伤(P=0.015)是颅脑外伤后并发低钠血症的危险因素。结论脑挫裂伤、蛛网膜下腔出血、弥漫性轴索损伤、GCS评分≤8分、脑水肿、颅底骨折和穿透性损伤的颅脑外伤患者更易发生低钠血症,应早期关注患者血清钠水平,明确病因及时纠正,防止病情恶化。

Objective To investigate the pathogenesis and risk factors of hyponatremia in patients with traumatic brain injury in order to provide references for early prediction and prevention.Methods A total of 185 patients diagnosed as moderate or severe traumatic brain injury were collected from June 2016 to June 2019 in our hospital.Clinical data such as different causes of hyponatremia,type of injury,sex,Glasgow coma scale(GCS)score,surgery,cerebral edema,basal skull fracture,and penetrating injury were collected and recorded.Univariateχ^2 test and multivariate Logistic regression analysis were used to explore the risk factors of hyponatremia after traumatic brain injury.ResultsHyponatremia occurred in 80 patients,including 47 cases of inadequate sodium intake and excessive diuretic use,19 cases of syndrome of inappropriate hormone secretion,14 cases of cerebral salt wasting syndrome.Hyponatremia occurred more frequently in patients with cerebral contusion and laceration,subarachnoid hemorrhage,and diffuse axonal injury and the difference was statistically significant(P<0.05).(编辑:刘艺)Univariateχ^2 test revealed that the GCS score(P=0.000),brain edema(P=0.000),skull base fracture(P=0.000),and penetrating injury(P=0.001)were the factors related to the hyponatremia after traumatic brain injury.Multivariate Logistic regression analysis revealed that the GCS score(P=0.006),brain edema(P=0.006),skull base fracture(P=0.000),and penetrating injury(P=0.015)were the factors related to hyponatremia after traumatic brain injury.Conclusion Traumatic brain injury patients with a cerebral contusion and laceration,subarachnoid hemorrhage,diffuse axonal injury,GCS score≤8,cerebral edema,basal skull fracture and penetrating injury are particularly prone to developing hyponatremia.Serum sodium levels of these patients should be monitored early and treated timely after identified the cause so as to prevent deterioration of their condition.