2015-2019年某医科大学第一附属医院住院患者低钠血症的病因分析

Etiological analysis of hyponatremia in inpatients of the First Affiliated Hospital of Anhui Medical University from 2015 to 2019

目的:分析某医科大学第一附属医院住院患者低钠血症的致病因素,帮助临床医生正确认识低钠血症,降低漏诊率及死亡率。方法:收集2015年1月1日-2019年12月31日于某医科大学第一附属医院住院治疗且病例资料记录完整的403例低钠血症患者临床资料,分析低钠血症患者性别、饮食情况等一般资料、病因分布、病情转归以及血钠水平的影响因素等。结果:轻、中、重度三组低钠血症患者的性别、饮食情况的分布无统计学差异,与低钠血症相关的原发基础疾病以呼吸系统疾病、内分泌系统疾病、消化系统疾病、中枢神经系统疾病居多。可致低血钠的药物中占比最高的为脱水剂和利尿剂,其次为质子泵抑制剂、抗肿瘤药、ACEI/ARB类药物、抗抑郁/抗精神病药物等。轻度低钠血症患者治愈率、死亡率略高于中、重度低钠血症患者,但重度低钠血症患者总体预后优于轻度低钠血症患者。住院天数、血Cl^(-)、血γ-GGT、血渗透压与血Na^(+)水平呈正相关,血白蛋白与血Na^(+)水平呈负相关,差异有统计学意义(P<0.05)。结论:低钠血症是住院患者最常见的电解质紊乱之一,低钠血症患者主要原发病是呼吸系统疾病、内分泌系统疾病、消化系统疾病和中枢神经系统疾病;恶性肿瘤特别是肺恶性肿瘤也易并发低钠血症;脱水剂和利尿剂的使用也对低钠血症的发生发展产生影响。血Cl^(-)、血γ-GGT浓度降低,血白蛋白浓度升高时容易合并低钠血症。重视对低钠血症的诊治,早期发现并及时处理,能降低低钠血症的漏诊率及死亡率。

Objective:To analyze the etiology and pathogenic factors of hyponatremia,to help clinicians correctly understand hyponatremia and to reduce the rate of missed diagnosis and mortality.Methods:Clinical data of inpatients with hyponatremia were collected.Etiologies,outcomes and The influencing factors of hyponatremia were summarized.Results:There were no statistical differences in gender and diet distribution among mild,moderate and severe hyponatremia patients.Hyponatremia were mostly related to respiratory system diseases,endocrine system diseases,digestive system diseases and central nervous system diseases.In the medication history of patients with hyponatremia,the highest proportion of drugs that can cause hyponatremia were dehydrants and diuretics,followed by proton pump inhibitors,antitumor drugs,ACEI/ARB drugs,antidepressants/antipsychotics,etc.The cure rate and mortality of patients with mild hyponatremia were slightly higher than those with moderate and severe hyponatremia,but the overall prognosis of patients with severe hyponatremia was better than that of patients with mild hyponatremia.The length of hospital stay,blood Cl^(-),bloodγ-glutamyltransferase,and blood osmotic pressure were positively correlated with the blood Na^(+)level,while the serum albumin was negatively correlated with the blood Na^(+)level,and the difference was statistically significant(P<0.05).Conclusion:Hyponatremia is one of the most common electrolyte disorders in inpatients with respiratory system diseases,endocrine system diseases,digestive system diseases and central nervous system diseases.Malignant tumors,especially lung malignant tumors are also easily complicated with hyponatremia;The use of dehydrating agents and diuretics also has an impact on the occurrence and development of hyponatremia.Patients with lower blood Cl^(-),lower bloodγ-glutamyltransferase and higher blood albumin concentration are more vulnerable for hyponatremia.More attention to hyponatremia,early detection and timely treatment can reduce the rate of missed diagnosis and mortality of hyponatremia.