高龄痴呆住院患者低钠血症的病因分析

Analysis of Etiology of Hyponatremia in Advanced Aged Inpatients with Dementia

目的探究高龄痴呆住院患者低钠血症的病因。方法选择2018年1月~2020年12月辽宁省金秋医院收治的150例高龄(年龄>80岁)痴呆住院患者作为研究对象。根据是否发生低钠血症(血钠浓度<135 mmol/L)分为正常组及低钠组,各75例,分析高龄痴呆患者低钠血症的病因。根据血钠水平将低钠组患者分为轻度低钠组51例(130 mmol/L≤血钠<135 mmol/L)、中度低钠组15例(125 mmol/L≤血钠<130 mmol/L)、重度低钠组9例(血钠<125 mmol/L),统计各组合并症的发生情况。结果低钠组血钠、血氯、红细胞计数、血红蛋白、白蛋白水平低于正常组,白细胞计数、血肌酐、尿素氮水平高于正常组,既往存在低钠血症史、鼻饲、卧床、应用排钠药物比例高于正常组,简易智力状态评定量表评分低于正常组,日常生活能力评分高于正常组,差异均有统计学意义(P<0.05);两组其他临床资料比较,差异均无统计学意义(P>0.05)。低钠组出现冠心病/心衰、慢性肾病、感染、恶性肿瘤的比例高于正常组,差异均有统计学意义(P<0.05)。轻度低钠组冠心病/心衰比例最高,中度低钠组感染比例最高,重度低钠组恶性肿瘤比例最高。结论高龄痴呆患者低钠血症原因与生存状态、合并症有关,临床表现无特异性,需进行预防,对高危因素进行积极监控及治疗。

Objective To explore the etiology of hyponatremia in advanced aged inpatients with dementia.Methods A total of 150 advanced aged patients(aged>80 years)with dementia admitted to Jinqiu Hospital of Liaoning Province from January 2018 to December 2020 were enrolled in this study.According to the occurrence of hyponatremia(serum sodium concentration<135 mmol/L),the patients were divided into a hyponatremia group(75 cases)and a normal serum sodium group(75 cases).The etiology of hyponatremia was analyzed in advanced aged patients with dementia.According to the level of serum sodium,the patients in the hyponatremia group were subdivided into a mild hyponatremia group(51 cases,130 mmol/L≤serum sodium<135 mmol/L),a moderate hyponatremia group(15 cases,125 mmol/L≤serum sodium<130 mmol/L),and a severe hyponatremia group(9 cases,serum sodium<125 mmol/L).The occurrence of comorbidity in each group was recorded.Results Compared with the normal serum sodium group,the hyponatremia group had lower levels of serum sodium,blood chloride,red blood cell count,hemoglobin and albumin;higher levels of white blood cell count,serum creatinine and blood urea nitrogen;higher proportion of history of hyponatremia,nasal feeding,bed rest and application of sodium-excreting drugs;lower Mini Mental State Examination score and higher Activity of Daily Living score.The differences were statistically significant between the two groups(P<0.05).There were no significant differences in other clinical data between the two groups(P>0.05).Compared with the normal serum sodium group,the hyponatremia group had higher proportions of coronary heart disease/heart failure,chronic kidney disease,infection,and malignant tumor(P<0.05).The mild hyponatremia group had the highest proportions of coronary heart disease and heart failure,the moderate hyponatremia group had the highest infection rate,and the severe hyponatremia group had the highest proportion of malignant tumors.Conclusion The causes of hyponatremia in advanced aged patients with dementia are closely related to survival status and comorbidity.The clinical manifestations are non-specific.It is necessary to prevent,actively monitor and treat the high-risk factors.