住院患者低鈉血癥的患病率和病因分析
發(fā)布時間：2019-07-02 16:39
【摘要】：[目的] 低鈉血癥是與發(fā)病率和死亡率增加有關(guān)的最常見的電解質(zhì)紊亂。本研究的目的是探討住院患者低鈉血癥的患病率及相關(guān)病因以及低鈉血癥對患者死亡預(yù)后的影響,以進(jìn)一步提高對該疾病的預(yù)防和診治水平。 [方法] 回顧性分析病案登記的于2014年1月到2014年4月間在我院住院治療的525例年齡≥14歲的低鈉血癥患者(男320例,女205例；≥60歲264例,60歲261例),根據(jù)血清鈉水平將低鈉血癥分為輕度、中度、重度低鈉血癥組(輕度低鈉血癥：130≤血鈉135mmol/L;中度低鈉血癥：125≤血鈉130mmol/Ll重度低鈉血癥：血鈉125mmol/L)。收集患者入院后首次測定的血鈉、血鉀、血滲透壓、腎功能、紅細(xì)胞壓積等指標(biāo),以出院前三天以內(nèi)晨起禁食狀態(tài)下抽取靜脈血測定的血鈉結(jié)果作為治療后血鈉。采集患者的病史資料,包括年齡、性別、體重指數(shù)、血壓、住院時間、低鈉治療時間、相關(guān)癥狀、相關(guān)的原發(fā)疾病、用藥史、診斷及病情轉(zhuǎn)歸。統(tǒng)計分析全院住院患者和老年住院患者低鈉血癥的患病率,對不同血鈉水平組一般臨床資料進(jìn)行比較,分析各組原發(fā)疾病的分布情況及常見病因,并應(yīng)用二分類logistic回歸模型分析低鈉血癥對患者死亡等預(yù)后的影響。 [結(jié)果] 1、全院住院患者中低鈉血癥的患病率為5.26%(552/9989),其中輕、中、重度低鈉血癥患病率分別為3.46%、1.35%、0.44%；老年住院患者低鈉血癥的患病率為6.1%(264/4334),其中輕、中、重度低鈉血癥患病率分別為3.65%、1.96%、0.49%。 2、整體低鈉血癥患者中輕度低鈉血癥原發(fā)疾病以惡性腫瘤(24.3%)、感染性疾病(20.5%)比例最高,中度低鈉血癥原發(fā)疾病以惡性腫瘤(25.9%)、腦出血(18.5%)及感染性疾病(17.8%)比例最高,重度低鈉血癥原發(fā)疾病以腦出血(31.8%)、惡性腫瘤(25%)及感染性疾病(11.4%)比例最高；老年低鈉血癥患者中原發(fā)疾病以惡性腫瘤(25%)、感染性疾病(19.7%)比例最高。 3、整體低鈉血癥患者中伴發(fā)SIADH和CSWS的比例各為13.7%和3.8%,老年低鈉血癥患者中伴發(fā)SIADH和CSWS的比例各為17.4%和4.2%,中重度低鈉血癥組排鈉藥物使用比例較輕度低鈉血癥組更高(P0.05)。 4、整體低鈉血癥患者預(yù)后分析結(jié)果為治愈比例70.1%,好轉(zhuǎn)比例10.8%,未愈比例14.5%,死亡比例4.6%；與輕度低鈉血癥組比較,中度低鈉血癥組治愈比例降低(P0.01),而好轉(zhuǎn)、未愈和死亡比例均增加,其中死亡比例增加具有顯著統(tǒng)計學(xué)差異性(P0.01)；與輕度低鈉血癥組比較,重度低鈉血癥組治愈比例降低(P0.01),而好轉(zhuǎn)、未愈和死亡比例均增加,且差異具有統(tǒng)計學(xué)意義(P0.05)或接近統(tǒng)計學(xué)差異(P=0.06)。而中度和重度低鈉血癥組間治愈率、好轉(zhuǎn)率、未愈及死亡率上并無統(tǒng)計學(xué)差異。二分類logistic回歸分析結(jié)果顯示,中度低鈉血癥組的死亡風(fēng)險是輕度低鈉血癥組的6.459倍(95%CI：2.360-17.683,P0.001),重度低鈉血癥組死亡風(fēng)險是輕度低鈉血癥組的4.8倍(95%CI：1.110-20.754,P=0.036),而重度低鈉血癥組與中度低鈉血癥組的死亡風(fēng)險無顯著性差異(P0.05)。 [結(jié)論] 住院患者低鈉血癥的患病率較高,而老年住院患者低鈉血癥的患病率更高。無論是整體還是老年低鈉人群,惡性腫瘤(肺癌)、感染性疾病(肺炎)和腦出血是低鈉血癥最常見的原發(fā)病因,而伴發(fā)SIADH釉CSWS是上述疾病導(dǎo)致低鈉血癥發(fā)生的重要原因。此外排鈉藥物的使用可能更易發(fā)生中重度低鈉血癥。而與輕度低鈉血癥組比較,中、重度低鈉血癥使得死亡風(fēng)險明顯增加。故在臨床工作中我們要密切關(guān)注低鈉血癥,并尋找低鈉血癥的相關(guān)病因積極診治。
[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.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R591.1
本文編號：2509095
[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.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R591.1
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