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目的探讨重症脑损伤急性期高钠血症的危险因素及对预后的影响。方法对1995年4月至2002年9月资料完整、格拉斯哥昏迷评分(GCS)≤8分的重症脑损伤(脑出血、脑梗死)急性期患者202例进行回顾性研究,分析病后1、3、7d高钠血症的发生率和病死率,并对患者病情特点进行分析。结果 202例中53例出现高钠血症,发生率26.24%;高钠血症的发生与GCS、APACHEⅡ评分、发热程度、饮水受限有关;病后1、3、7d高钠血症的发生率分别为1.98%、7.92%、16.34%;病后7d高钠血症病死率为45.28%,明显较病后1d(1.89%)发生率高(P<0.01);病后7d高钠血症患者病死率较病后未伴高钠血症患者明显增高。结论重症脑损伤急性期高钠血症与脑本身病理机制有关,病后7d出现高钠血症是致死的重要危险因素。
Objective To explore the risk factors of hypernatremia in acute brain injury and its prognosis. Methods A retrospective study was conducted on 202 patients with acute brain injury (cerebral hemorrhage, cerebral infarction) with complete data and Glasgow Coma Scale (GCS) ≤8 from April 1995 to September 2002. , 7d incidence of hypernatremia and mortality, and analysis of the patient’s disease characteristics. Results In 202 cases, 53 cases showed hypernatremia, the incidence rate was 26.24%. The incidence of hypernatremia was related to GCS, APACHEⅡ score, fever degree and drinking water limitation. The incidence of hypernatremia at 1, 3 and 7 days The mortality rate of hypernatremia was 45.28% at 7 days after the illness, which was significantly higher than that at 1 day (1.89%) (P <0.01). After 7 days, the incidence of hypernatremia Patient mortality was significantly higher than patients without concomitant hypernatremia. Conclusions Hypernatremia in the acute stage of severe brain injury is related to the pathological mechanism of the brain itself. The occurrence of hypernatremia 7 days after the illness is an important risk factor for lethality.