住院患者低钠血症的患病率和病因分析

发布时间：2019-07-02 16:39

【摘要】：[目的] 低钠血症是与发病率和死亡率增加有关的最常见的电解质紊乱。本研究的目的是探讨住院患者低钠血症的患病率及相关病因以及低钠血症对患者死亡预后的影响,以进一步提高对该疾病的预防和诊治水平。 [方法] 回顾性分析病案登记的于2014年1月到2014年4月间在我院住院治疗的525例年龄≥14岁的低钠血症患者(男320例,女205例；≥60岁264例,60岁261例),根据血清钠水平将低钠血症分为轻度、中度、重度低钠血症组(轻度低钠血症：130≤血钠135mmol/L;中度低钠血症：125≤血钠130mmol/Ll重度低钠血症：血钠125mmol/L)。收集患者入院后首次测定的血钠、血钾、血渗透压、肾功能、红细胞压积等指标,以出院前三天以内晨起禁食状态下抽取静脉血测定的血钠结果作为治疗后血钠。采集患者的病史资料,包括年龄、性别、体重指数、血压、住院时间、低钠治疗时间、相关症状、相关的原发疾病、用药史、诊断及病情转归。统计分析全院住院患者和老年住院患者低钠血症的患病率,对不同血钠水平组一般临床资料进行比较,分析各组原发疾病的分布情况及常见病因,并应用二分类logistic回归模型分析低钠血症对患者死亡等预后的影响。 [结果] 1、全院住院患者中低钠血症的患病率为5.26%(552/9989),其中轻、中、重度低钠血症患病率分别为3.46%、1.35%、0.44%；老年住院患者低钠血症的患病率为6.1%(264/4334),其中轻、中、重度低钠血症患病率分别为3.65%、1.96%、0.49%。 2、整体低钠血症患者中轻度低钠血症原发疾病以恶性肿瘤(24.3%)、感染性疾病(20.5%)比例最高,中度低钠血症原发疾病以恶性肿瘤(25.9%)、脑出血(18.5%)及感染性疾病(17.8%)比例最高,重度低钠血症原发疾病以脑出血(31.8%)、恶性肿瘤(25%)及感染性疾病(11.4%)比例最高；老年低钠血症患者中原发疾病以恶性肿瘤(25%)、感染性疾病(19.7%)比例最高。 3、整体低钠血症患者中伴发SIADH和CSWS的比例各为13.7%和3.8%,老年低钠血症患者中伴发SIADH和CSWS的比例各为17.4%和4.2%,中重度低钠血症组排钠药物使用比例较轻度低钠血症组更高(P0.05)。 4、整体低钠血症患者预后分析结果为治愈比例70.1%,好转比例10.8%,未愈比例14.5%,死亡比例4.6%；与轻度低钠血症组比较,中度低钠血症组治愈比例降低(P0.01),而好转、未愈和死亡比例均增加,其中死亡比例增加具有显著统计学差异性(P0.01)；与轻度低钠血症组比较,重度低钠血症组治愈比例降低(P0.01),而好转、未愈和死亡比例均增加,且差异具有统计学意义(P0.05)或接近统计学差异(P=0.06)。而中度和重度低钠血症组间治愈率、好转率、未愈及死亡率上并无统计学差异。二分类logistic回归分析结果显示,中度低钠血症组的死亡风险是轻度低钠血症组的6.459倍(95%CI：2.360-17.683,P0.001),重度低钠血症组死亡风险是轻度低钠血症组的4.8倍(95%CI：1.110-20.754,P=0.036),而重度低钠血症组与中度低钠血症组的死亡风险无显著性差异(P0.05)。 [结论] 住院患者低钠血症的患病率较高,而老年住院患者低钠血症的患病率更高。无论是整体还是老年低钠人群,恶性肿瘤(肺癌)、感染性疾病(肺炎)和脑出血是低钠血症最常见的原发病因,而伴发SIADH釉CSWS是上述疾病导致低钠血症发生的重要原因。此外排钠药物的使用可能更易发生中重度低钠血症。而与轻度低钠血症组比较,中、重度低钠血症使得死亡风险明显增加。故在临床工作中我们要密切关注低钠血症,并寻找低钠血症的相关病因积极诊治。
[Abstract]:[Objective] Hyponatremia is the most common electrolyte associated with an increase in morbidity and mortality. The purpose of this study is to investigate the prevalence of hyponatremia and the related causes of hyponatremia and the effect of hyponatremia on the prognosis of the patient's death in order to further improve the prevention and treatment of the disease. Flat. [Methods] A retrospective analysis of 525 cases of hyponatremia in the hospital in our hospital from January 2014 to April 2014 (320 males and 205 females,264 from 60 years of age,261 in 60 years of age) were retrospectively analyzed, and the hyponatremia was divided into two groups according to the serum sodium level. Mild, moderate, severe hyponatremia (mild hyponatremia:130 hypernatremia 135 mmol/ L; moderate hyponatremia:125 hypernatremia 130 mmol/ L severe hyponatremia: blood sodium 125 mm Ol/ L). The blood sodium, blood potassium, blood pressure, renal function, and hematocrit were collected for the first time after the patient was admitted to the hospital, and the blood sodium result of venous blood determination was taken as the blood sodium result in the morning and fasted state within three days before the discharge of the hospital. Blood sodium after treatment. The patient's medical history data was collected, including age, sex, body weight index, blood pressure, hospital stay, low sodium treatment time, related symptoms, related primary disease, history of medication, diagnosis, The prevalence of hyponatremia in all-hospital and elderly patients was analyzed. The general clinical data of different blood sodium levels were compared, and the distribution of primary diseases in each group was analyzed. And using the two-classification logistic regression model to analyze the hyponatremia to the death of the patient. the shadow of the prognosis The prevalence of hyponatremia in all hospital patients was 5.26% (552/9989). The prevalence of hyponatremia in the patients with mild, moderate and severe hyponatremia was 3.46%, 1.35% and 0.44%, respectively. The prevalence of hyponatremia in elderly patients was 6.1% (264/43). 34) The prevalence of mild, moderate and severe hyponatremia was 3.65%,1. The primary diseases of mild hyponatremia in the patients with hyponatremia were malignant tumor (24.3%), infectious disease (20.5%), moderate hyponatremia, malignant tumor (25.9%), cerebral hemorrhage (18.5%) and infectious diseases. (17.8%) of the patients with hyponatremia were the highest in the case of cerebral hemorrhage (31.8%), malignant tumor (25%) and infectious disease (11.4%), and in the patients with hyponatremia in the elderly, the primary diseases were malignant (25%) and infectious diseases. The proportion of SIADH and CSWS in patients with hyponatremia was 13.7% and 3.8%, respectively. The proportion of SIADH and CSWS in patients with hyponatremia in the elderly was 17.4% and 4.2%, and the proportion of patients with moderate to severe hyponatremia was slightly lower. The results of the prognosis of the whole hyponatremia group were 70.1%, 10.8%, 14.5% and 4.6% respectively, and the proportion of the patients with moderate hyponatremia was lower than that of the mild hyponatremia group (P0.01). There was a significant difference in the proportion of patients with severe hyponatremia (P0.01), and the proportion of the patients with severe hyponatremia was lower (P0.01), and the ratio of unhealing and death was increased, and the difference was statistically significant (P0.05). Near statistical difference (P = 0.06). The cure rate and rate of improvement between moderate and severe hyponatremia groups There was no statistical difference in the recovery and mortality. The two-class logistic regression analysis showed that the risk of death in the moderate hyponatremia group was 6.45times (95% CI: 2.360-17.683, P0.001) in the mild hyponatremia group, and the risk of death in the severe hyponatremia group was 4.8 times (95% CI: 1.110- 20.754, P = 0.036), while the death of the severe hyponatremia group and the moderate hyponatremia group The risk is not obvious [Conclusion] The prevalence of hyponatremia in hospitalized patients is higher than that in the hospital. High, and the prevalence of hyponatremia in elderly patients is higher, whether in the whole or in the elderly, low-sodium, malignant (lung), infectious diseases (pneumonia) and cerebral hemorrhage are the most common primary cause of hyponatremia, with SIADH-glazed CSW. S is an important cause of the occurrence of hyponatremia as a result of the above-mentioned disease. In addition, The use of sodium drugs may be more susceptible to moderate to severe hyponatremia compared to mild hyponatremia. In the clinical work, we should pay close attention to the low sodium.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R591.1

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