完全性颈脊髓损伤患者早期发生低钠血症的多因素分析

发布时间：2018-05-17 13:56

本文选题：颈脊髓损伤 + 低钠血症　；参考：《中国微创外科杂志》2017年03期

【摘要】：目的探讨导致急性完全性颈脊髓损伤患者早期出现低钠血症的相关因素。方法回顾性分析2010年1月~2015年12月完全性颈脊髓损伤患者49例临床资料。以连续2次(间隔24 h)血钠135 mmol/L为低钠血症的诊断标准,合并低钠血症的26例为低钠血症组,未合并低钠血症的23例为对照组。对年龄,性别,颈脊髓损伤最高节段、损伤程度,是否使用糖皮质激素治疗,是否合并神经源性休克,平均每日尿量,平均每日液体平衡量,转入危重医学科时血钠水平和血浆白蛋白水平共10项指标进行单因素分析,单因素分析有统计学意义(P0.05)的指标再进行logistic逐步回归分析。计量资料单因素分析有统计学意义的指标通过绘制ROC曲线确定其最佳临界点。结果单因素分析中,2项指标在2组间有统计学差异(P0.05),低钠血症组患者低钠血症发生前神经源性休克发生率为57.7%(15/26),对照组为26.1%(6/23)(χ~2=6.516,P=0.011);低钠血症组患者平均每日尿量(2225±389)ml,对照组(1936±289)ml(t=2.924,P=0.005)。logistic逐步回归分析显示这两项因素均为完全性颈脊髓损伤患者早期发生低钠血症的独立影响因素(OR=13.708、0.996,P=0.004、0.002)。ROC曲线显示平均每日尿量的最佳临界点为2331 ml。结论并发神经源性休克与平均每日尿量2331 ml为完全性颈脊髓损伤患者早期发生低钠血症的独立影响因素。
[Abstract]:Objective to investigate the related factors of hyponatremia in patients with acute complete cervical spinal cord injury. Methods the clinical data of 49 patients with complete cervical spinal cord injury from January 2010 to December 2015 were retrospectively analyzed. Blood sodium 135 mmol/L was used as diagnostic criteria for hyponatremia, 26 patients with hyponatremia and 23 patients without hyponatremia as control group. For age, sex, the highest segment of cervical spinal cord injury, the degree of injury, whether or not to use glucocorticoid therapy, whether to combine with neurogenic shock, average daily urine volume, average daily fluid balance, Ten indexes of serum sodium level and plasma albumin level were analyzed by univariate analysis, and the logistic stepwise regression analysis was performed on the indexes with statistical significance (P 0.05). The single factor analysis of measurement data determines the optimal critical point by drawing ROC curve. Results in univariate analysis, there were significant differences between the two groups in the two groups (P 0.05). The incidence of neurogenic shock before hyponatremia in the hyponatremia group was 57.7% / 26%, and that in the control group was 26.1D / 23% (蠂 ~ (2) 2 + 6.516) P0.0111.The average daily urine volume in the hyponatremia group was 2225 卤389ml, while in the control group, the average daily urine volume was 2225 卤389ml. Logistic stepwise regression analysis showed that these two factors were independent influencing factors of hyponatremia in patients with complete cervical spinal cord injury. Conclusion Neurogenic shock and average daily urine volume of 2331 ml are independent factors of hyponatremia in patients with complete cervical spinal cord injury.
【作者单位】：北京大学第三医院危重医学科;
【基金】：首都医学发展科研基金(2009-1014)
【分类号】：R651.2;R591.1

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