中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2013年
11期
28-30
,共3页
蔡建勇%巴华君%陆川%孙军
蔡建勇%巴華君%陸川%孫軍
채건용%파화군%륙천%손군
危险因素%低钠血症%回归分析%动脉瘤夹闭术后
危險因素%低鈉血癥%迴歸分析%動脈瘤夾閉術後
위험인소%저납혈증%회귀분석%동맥류협폐술후
Risk factors%Hyponatremia%Regression analysis%Postoperative with aneurysm
目的 探讨动脉瘤夹闭术后低钠血症的相关危险因素,并对其临床特点进行分析,为其临床的诊断及治疗提供参考.方法 共纳入120例行动脉瘤夹闭术患者,详细记录患者的病史及基本信息,根据其是否发生低钠血症分为两组,应用多因素Logistic回归分析进行多因素分析.结果 120例行动脉瘤夹闭术患者术后有45例(37.5％)出现低钠血症(病例组),血钠(125.2±10.1)mmol/L,出现低钠血症时间(8.2±0.8)d,其中第1个高峰(术后1～3 d)15例,第2个高峰(术后8～9d) 25例,其余时间5例；颈内动脉系统动脉瘤39例,椎-基底动脉系统动脉瘤6例.单因素分析结果表明,对照组和病例组年龄、术前格拉斯哥昏迷量表(GCS)评分、高血压病史、糖尿病病史、急诊手术、动脉瘤大小及中动脉动脉瘤比例比较差异有统计学意义[(48.7±8.4)岁比(54.7±8.4)岁、(14.4±3.1)分比(10.3±3.4)分、26.7％(20/75)比60.0％ (27/45)、33.3％(25/75)比62.2％ (28/45)、32.0％ (24/75)比62.2％ (28/45)、(0.9±0.3) cm比(1.4±0.4) cm、24.0％(18/75)比42.2％(19/45),P＜0.01或＜0.05].进一步行多因素分析结果表明,术前GCS评分下降、急诊手术是动脉瘤夹闭术后出现低钠血症的独立危险因素(P＜0.05).结论 术后1 ～3d及8～9d是动脉瘤夹闭术后出现低钠血症的高峰,对于不同高峰阶段需要采用不同的治疗方法.术前GCS评分下降、急诊手术是动脉瘤夹闭术后出现低钠血症的独立危险因素,临床工作中需重视上述危险因素并给予相应的治疗及预防.
目的 探討動脈瘤夾閉術後低鈉血癥的相關危險因素,併對其臨床特點進行分析,為其臨床的診斷及治療提供參攷.方法 共納入120例行動脈瘤夾閉術患者,詳細記錄患者的病史及基本信息,根據其是否髮生低鈉血癥分為兩組,應用多因素Logistic迴歸分析進行多因素分析.結果 120例行動脈瘤夾閉術患者術後有45例(37.5％)齣現低鈉血癥(病例組),血鈉(125.2±10.1)mmol/L,齣現低鈉血癥時間(8.2±0.8)d,其中第1箇高峰(術後1～3 d)15例,第2箇高峰(術後8～9d) 25例,其餘時間5例；頸內動脈繫統動脈瘤39例,椎-基底動脈繫統動脈瘤6例.單因素分析結果錶明,對照組和病例組年齡、術前格拉斯哥昏迷量錶(GCS)評分、高血壓病史、糖尿病病史、急診手術、動脈瘤大小及中動脈動脈瘤比例比較差異有統計學意義[(48.7±8.4)歲比(54.7±8.4)歲、(14.4±3.1)分比(10.3±3.4)分、26.7％(20/75)比60.0％ (27/45)、33.3％(25/75)比62.2％ (28/45)、32.0％ (24/75)比62.2％ (28/45)、(0.9±0.3) cm比(1.4±0.4) cm、24.0％(18/75)比42.2％(19/45),P＜0.01或＜0.05].進一步行多因素分析結果錶明,術前GCS評分下降、急診手術是動脈瘤夾閉術後齣現低鈉血癥的獨立危險因素(P＜0.05).結論 術後1 ～3d及8～9d是動脈瘤夾閉術後齣現低鈉血癥的高峰,對于不同高峰階段需要採用不同的治療方法.術前GCS評分下降、急診手術是動脈瘤夾閉術後齣現低鈉血癥的獨立危險因素,臨床工作中需重視上述危險因素併給予相應的治療及預防.
목적 탐토동맥류협폐술후저납혈증적상관위험인소,병대기림상특점진행분석,위기림상적진단급치료제공삼고.방법 공납입120례행동맥류협폐술환자,상세기록환자적병사급기본신식,근거기시부발생저납혈증분위량조,응용다인소Logistic회귀분석진행다인소분석.결과 120례행동맥류협폐술환자술후유45례(37.5％)출현저납혈증(병례조),혈납(125.2±10.1)mmol/L,출현저납혈증시간(8.2±0.8)d,기중제1개고봉(술후1～3 d)15례,제2개고봉(술후8～9d) 25례,기여시간5례；경내동맥계통동맥류39례,추-기저동맥계통동맥류6례.단인소분석결과표명,대조조화병례조년령、술전격랍사가혼미량표(GCS)평분、고혈압병사、당뇨병병사、급진수술、동맥류대소급중동맥동맥류비례비교차이유통계학의의[(48.7±8.4)세비(54.7±8.4)세、(14.4±3.1)분비(10.3±3.4)분、26.7％(20/75)비60.0％ (27/45)、33.3％(25/75)비62.2％ (28/45)、32.0％ (24/75)비62.2％ (28/45)、(0.9±0.3) cm비(1.4±0.4) cm、24.0％(18/75)비42.2％(19/45),P＜0.01혹＜0.05].진일보행다인소분석결과표명,술전GCS평분하강、급진수술시동맥류협폐술후출현저납혈증적독립위험인소(P＜0.05).결론 술후1 ～3d급8～9d시동맥류협폐술후출현저납혈증적고봉,대우불동고봉계단수요채용불동적치료방법.술전GCS평분하강、급진수술시동맥류협폐술후출현저납혈증적독립위험인소,림상공작중수중시상술위험인소병급여상응적치료급예방.
Objective To explore the risk factors of hyponatremia in postoperative patients with aneurysm and analyze the clinical characterstics in order to provide reference for clinic.Methods Participants included 120 patients who treated by aneurysm occlusion.Detailed recorded the patient's history and basic information.The patients with hyponatremia were in case group,and other patients were in control group.The risk factors of hyponatremia were analyzed.Results Forty-five patients (37.5％) occurred hyponatremia after operation.The level of natrium was (125.2 ± 10.1) mmol/L,the average time of appear hyponatremia was (8.2 ± 0.8) d,15 patients were in the first peak(postoperative 1-3 d),25 patients were in the second peak (postoperative 8-9 d),5 patients occurred hyponatremia at other time.Thirty-nine patients were internal carotid artery aneurysms,6 patients were vertebrobasilar artery aneurysms.Single factor analysis showed that the age,preoperative GCS scores,history of hypertension and diabetes,emergency operation,the size of arterial aneurysms,medium-sized aneurysm of artery between two groups had significant difference [(48.7 ± 8.4) years vs.(54.7 ± 8.4) years,(14.4 ± 3.1) scores vs.(10.3 ± 3.4)scores,26.7％ (20/75) vs.60.0％ (27/45),33.3％ (25/75) vs.62.2％ (28/45),32.0％ (24/75) vs.62.2％(28/45),(0.9 ±0.3) cm vs.(1.4 ±0.4) cm,24.0％(18/75) vs.42.2％(19/45),P ＜ 0.01 or ＜ 0.05].Multifactors regression analysis showed that preoperative GCS scores,emergency operation were the independent risk factors of hyponatremia (P＜ 0.05).Conclusions Postoperative 1-3 d and 8-9 d are the peak stage of hyponatremia.Different treatment should be adopted according the peak stage.Lower scores of preoperative GCS and emergency operation are the independent risk factors of hyponatremia.Clinical work need to pay more attention to the risk factors,appropriate treatment and prevention.
