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目的观察重型颅脑损伤伴高钠血症患者24 h尿钠的变化情况。方法选取2015年8月—2016年8月收治的重型颅脑损伤患者40例,根据血钠水平分为高钠血症组与正常血钠组各20例,同期选取成年健康志愿者20例为正常对照组。检测各组24 h尿钠水平。比较各组间急性生理与慢性健康评分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)、24 h出入量、血钠、钠摄入量及肌酐等的差异,并进一步分析三组预后。计量资料多组比较采用方差分析,两两比较采用SNK法,P<0.05为差异有统计学意义。结果与正常血钠组比较,高钠血症组APACHEⅡ评分、血钠均升高(均P<0.05)。与正常对照组比较,正常血钠组APACHEⅡ评分升高(均P<0.05)。高钠血症组、正常血钠组、正常对照组24 h尿钠水平分别为(179.10±31.84)、(211.10±29.01)、(203.00±33.11)mmol。与正常血钠组及正常对照组比较,高钠血症组24 h尿钠水平降低,比较差异有统计学意义(均P<0.05);正常血钠组与正常对照组24 h尿钠总量比较差异无统计学意义(P>0.05)。与正常血钠组(0例)比较,高钠血症组死亡率(60%)高(P<0.05),正常血钠组与正常对照组死亡率比较差异无统计学意义(P>0.05)。结论重型颅脑损伤并发高钠血症患者24 h尿钠水平低于正常血钠患者,提示钠排泄降低可能是高钠血症发生的重要原因,且与患者病情危重程度及预后相关。
Objective To observe the changes of 24 h urinary sodium in patients with severe craniocerebral injury and hypernatremia. Methods Forty patients with severe craniocerebral injury admitted in our hospital from August 2015 to August 2016 were divided into two groups according to the level of serum sodium: 20 cases in each group and 20 cases in normal sodium group Normal control group. 24 h urinary sodium levels were detected in each group. The acute physiology and chronic health evaluation Ⅱ (APACHEⅡ), the amount of excretion, serum sodium, sodium intake and creatinine were compared among groups. The prognosis of the three groups were further analyzed. Measurement data were compared using multiple groups analysis of variance, compared with each SNK SN method, P <0.05 for the difference was statistically significant. Results Compared with normal sodium group, APACHE Ⅱ score and serum sodium in hypernatremia group were significantly increased (all P <0.05). Compared with the normal control group, the APACHEⅡscores in the normal sodium group increased (all P <0.05). The levels of 24 h urinary sodium in hypernatremia group, normal serum sodium group and normal control group were (179.10 ± 31.84), (211.10 ± 29.01) and (203.00 ± 33.11) mmol, respectively. Compared with normal serum sodium group and normal control group, 24 h urine sodium level in hypernatremia group decreased significantly (all P <0.05); 24 h urinary sodium total volume in normal sodium group and normal control group The difference was not statistically significant (P> 0.05). Compared with normal sodium group (n = 0), the mortality in hypernatremia group (60%) was high (P <0.05), and there was no significant difference in mortality between normal sodium group and normal control group (P> 0.05) . Conclusions Patients with severe craniocerebral injury complicated with hypernatremia have a lower 24-hour urinary sodium level than those with normal serum sodium, suggesting that decreased sodium excretion may be an important cause of hypernatremia and is related to the severity of the disease and prognosis.