320例脑挫裂伤患者电解质变化与术后死亡的相关性

Correlation between electrolyte changes and postoperative death in 320 patients with cerebral contusion

目的探讨脑挫裂伤患者的电解质变化,并分析其与患者术后死亡的相关性。方法选取2017年11月—2019年10月我院急诊科收入院的成人脑挫裂伤患者320例(需要急诊开颅手术),根据入院时格拉斯哥昏迷量表(GCS)评分将其分(轻、中、重)组。分析患者入院时及术后24 h内的电解质紊乱类型,并记录死亡率,应用多变量logistic回归分析电解质紊乱与病死率增高的危险因素。结果脑挫裂伤患者多见于男性,低钾血症术前常见(65.63%,210/320),平均值为(3.27±0.91)mmol/L;酸中毒术后常见(67.81%,217/320),平均值为(20.57±2.82)mmol/L。logistic回归分析结果示高钠血症、酸中毒是患者术后24 h内病死率增高的危险因素,其危险度分别为20.241(27.550~6.497)和4.012(2.921~1.023)。结论低钾血症、酸中毒分别是脑挫裂伤患者术前与术后最常见的电解质紊乱类型;围手术期高钠血症、酸中毒显著增加患者术后24 h内的病死率。

Objective To investigate the electrolyte changes in patients with cerebral contusion and analyze the risk factors of postoperative death.Methods Three hundred and twenty adult patients with cerebral contusion who required emergency craniotomy were enrolled in our hospital from November 2017 to October 2019.They were divided into three groups according to GCS scale at admission(mild group,medium group and severe group).The types of electrolyte disorders at the time of admission and within 24 hours after operation were analyzed,and the mortality was recorded.Multivariate logistic regression was used to analyze the risk factors of electrolyte disorders and mortality.Results Patients with cerebral contusion were more common in men;hypokalemia was common before operation(65.63%,210/320),with an average of(3.27±0.91)mmol/L.Acidosis was common after operation(67.81%,217/320),with an average of(20.57±2.82)mmol/L.Logistic regression analysis showed that hypernatremia and acidosis were risk factors for increased mortality within 24 hours after operation.The risk degree was 20.241(27.550-6.497)and 4.012(2.921-1.023)respectively.Conclusion The most common types of electrolyte disorders before and after operation are hypokalemia and acidosis respectively in patients with cerebral contusion.Hypernatremia and acidosis significantly increase the mortality within 24 hours after operation during perioperative period.