学术论文

      低钠血症对慢性阻塞性肺疾病并发症与预后的影响

      Effect of hyponatremia on complications and prognosis in patients with acute exacerbation of chronic obstruc-tive pulmonary disease

      摘要:
      目的:观察低钠血症对慢性阻塞性肺疾病急性加重期患者并发症及病死率的影响。方法选择慢性阻塞性肺疾病急性加重期患者317例分为非低钠血症组252例和低钠血症组65例,比较两组一般情况、血清离子、血气、APACHE II 评分、住院期间并发症、呼吸机使用情况、病死率之间的差异,并绘制采试者工作特征(ROC)曲线,获取更高病死率的血钠值截点。结果低钠血症组患者体质量(68.3±14.4)kg、体质量指数(BMI)(25.5±4.9)kg/m2,非低钠血症组体质量(74.9±15.9)kg、BMI(28.2±5.3)kg/m2,两组差异均有统计学意义(t =12.009、8.494,均 P <0.05);低钠血症组肺炎发生率(23.1%)高于非低钠血症组(13.1%)(χ2=4.007,P =0.045);低钠血症组住院天数[(13.1±8.9)d]长于非低钠血症组[(7.8±4.9)d](t =15.638,P =0.000);低钠血症组有创通气天数[(1.1±0.4)d]长于非低钠血症组[(0.9±0.1)d](t =2.885, P =0.004);低钠血症组无创通气天数[(3.1±0.8)d]长于非低钠血症组[(0.8±0.3)d](t =2.984,P =0.003);低钠血症组住院期间病死率(12.3%)高于非低钠血症组(3.1%)(χ2=7.189,P =0.007);低钠血症组90 d 内病死率(29.2%)高于非低钠血症组(15.1%)(χ2=7.017,P =0.008)。绘制 ROC 曲线发现当血清钠截点值为128.8 mmol/L,低于该值的患者病死率为26.3%,高于该值病死率为3.7%。结论低钠血症与慢性阻塞性肺疾病患者病情严重程度及预后相关,应重视低钠血症的存在,并积极预防及纠正低钠血症。
      Abstract:
      Objective To observe the complications and mortality of hyponatremia in patients with acute exacerbation of chronic obstructive pulmonary disease.Methods The patients with acute exacerbation of chronic obstructive pulmonary disease were selected and divided into non -hyponatremia group(252 cases)and hyponatremia group(65 cases).The differences in the general status,serum ions,blood gas,APACHE Ⅱ score,complications dur-ing the hospitalization,using of ventilator and mortality between the two groups were compared,and drew the receiver operating characteristic(ROC)curve,to acquire higher serum sodium cut -off values.Results In the hyponatremia group,the body weight was (68.3 ±14.4)kg,BMI was (25.5 ±4.9)kg/m2 ,those in the non -hyponatremia group were (74.9 ±15.9)kg and (28.2 ±5.3)kg/m2 respectively,there were statistically significant differences(t =2.009,8.494,all P <0.05).The incidence rate of pneumonia in the hyponatremia group was 23.1%,which was higher than 13.1% in the non -hyponatremia group(χ2 =4.007,P =0.045).The hospital days of the hyponatremia group was (13.1 ±8.9)d,which was longer than (7.8 ±4.9)d of the non -hyponatremia group(t =15.638,P =0.000).The invasive ventilation days of the hyponatremia group was (1.1 ±0.4)d,which was longer than (0.9 ± 0.1)d of the non -hyponatremia group(t =2.885,P =0.004).The non invasive ventilation days of the hyponatremia group was (3.1 ±0.8)d,which was longer than (0.8 ±0.3)d of the non -hyponatremia group (t =2.984,P =0.003).The hospital mortality rate of the hyponatremia group was 12.3%,which was higher than 3.1% of the non -hyponatremia group(χ2 =7.189,P =0.007).The 90 -day mortality rate of the hyponatremia group was 29.2%,&nbsp;which was higher than 15.1% of the non -hyponatremia group(χ2 =7.017,P =0.008).When the serum sodium cut-off value was 128.8mmol/L by drawing ROC curve,the mortality rate in patients with lower than this value was 26.3%,while the mortality rate in patients with higher than the value was 3.7%.Conclusion Hyponatremia is related with the severity and prognosis of acute exacerbation of chronic obstructive pulmonary disease.It is most important to prevent and correct hyponatremia at early disease stage.
      Author: Xiao Jinghua Tian Dongbo Chen Zisheng Chen Weiping Liao Xiaowen Zhang Yifei
      作者单位: 广州医科大学附属第六医院 清远市人民医院呼吸内科, 广东省清远,511500
      刊 名: 中国基层医药 ISTIC
      年,卷(期): 2017, 24(6)
      在线出版日期: 2017年3月29日