宫腹腔镜联合手术患者发生症状性低钠血症的影响因素分析

Analysis of influencing factors of symptomatic hyponatremia in patients undergoing hysteroscopy combined with laparoscopy

目的探讨宫腹腔镜联合手术患者发生症状性低钠血症的影响因素。方法选取2018年1月至2019年10月首都医科大学附属北京妇产医院妇科微创中心进行宫腹腔镜联合手术患者201例。根据术后是否发生症状性低钠血症分为症状性低钠血症组(67例)和对照组(134例),选取同期年龄与症状性低钠血症组相差不超过2岁,手术方式相同的患者进行1∶2配比形成对照组,如多个符合则选择年龄最接近的患者。采用多因素logistic回归分析宫腹腔镜联合手术后发生症状性低钠血症的影响因素。结果201例患者中,年龄20~52岁,平均(34.1±6.6)岁。多因素logistic回归分析结果显示,腹泻次数≥10次(OR=2.636,95%CI:1.816~25.849,P=0.006)、宫腔镜手术时间≥30 min(OR=2.052,95%CI:0.024~19.845,P=0.000)、灌流液量≥3000 ml(OR=1.436,95%CI:0.122~15.623,P=0.016)的患者更容易发生症状性低钠血症。结论腹泻次数、宫腔镜手术时间、灌流液量是宫腹腔镜联合手术患者发生症状性低钠血症的影响因素,术前需充分评估肠道准备必要性及其程度,密切关注患者腹泻次数,加强电解质管理,监测术中灌流液用量,控制宫腔镜手术时间,及时给予处理措施。

Objective To explore the influencing factors of symptomatic hyponatremia in patients undergoing hysteroscopy combined with laparoscopy.Methods A total of 201 patients with hysteroscopy and laparoscopy in Gynecological Minimally Invasive Center of Beijing Obstetrics and Gynecology Hospital,Capital Medical University from January 2018 to October 2019 were selected,and were devided into symptomatic hyponatremia group(67 cases)and control group(134 cases)according to whether symptomatic hyponatremia occurred after hysteroscopy combined with laparoscopy.The patients with age difference of no more than two years and the same surgical method in the same period were selected for 1:2 ratio to form the control group.If multiple patients met the criteria,the patients with the closest age were selected.The influencing factors of symptomatic hyponatremia in patients undergoing hysteroscopy combined with laparoscopy was analyzed by multivariate logistic regression.Results Among the 201 patients,aged from 20 to 50 years,with an average age of(34.1±6.6)years.Multivariate logistic regression analysis showed that the patients with diarrhea times≥10(OR=2.636,95%CI:1.816-25.849,P=0.006),hysteroscopic surgery time≥30 min(OR=2.052,95%CI:0.024-19.845,P=0.000),and perfusion volume≥3000 ml(OR=1.436,95%CI:0.122-15.623,P=0.016)were more likely to develop symptomatic hyponatremia.Conclusions Diarrhea times,hysteroscopic surgery time and perfusion volume are the influencing factors of symptomatic hyponatremia in patients undergoing hysteroscopy combined with laparoscopy,and should fully evaluate the necessity and degree of intestinal preparation before operation,pay close attention to the times of diarrhea,strengthen electrolyte management,monitor the amount of perfusion fluid during operation,control the time of hysteroscopy operation and give timely treatment measures.