Ayus J C, Wheeler J M, Arieff A I
Baylor College of Medicine, Houston, Texas.
Ann Intern Med. 1992 Dec 1;117(11):891-7. doi: 10.7326/0003-4819-117-11-891.
To determine factors associated with the development of encephalopathy and with its clinical course in patients with postoperative hyponatremia.
Consultation and referral services of two university medical centers and community hospitals.
Case-control study (risk factors for encephalopathy) and cohort study (clinical course among patients with encephalopathy).
Case patients included 65 adults with postoperative hyponatremic encephalopathy; controls included 674 adult patients who had postoperative hyponatremia without encephalopathy and who were selected from 76,678 consecutive adult surgical inpatients.
Age, gender, menstrual status, neurologic symptoms, time to development and degree of hyponatremia, arterial blood gas determinations, serum chemistries, morbidity and mortality.
Case patients included 40 women (62%) and 25 men (38%) (P > 0.05); controls included 367 women (54%) and 307 men (46%) (P > 0.1). Of the 34 case patients who developed permanent brain damage or died, 33 (97%) were women (P < 0.001). Among the women with brain damage, 25 (76%) were menstruant (P < 0.001). The relative risk for death or permanent brain damage from hyponatremic encephalopathy in women compared with men was 28 (95% Cl, 5 to 141) and in menstruant women compared with postmenopausal women, 26 (Cl, 11 to 62). Arterial PO2 at diagnosis was significantly lower in female than in male case patients (34 +/- 5 compared with 91 +/- 3 mm Hg; P < 0.001). Further, of the 38 case patients who had respiratory arrest before the diagnosis of hyponatremic encephalopathy, 36 (95%) were women. Extent of or time to development of hyponatremia did not correlate with subsequent brain damage (P > 0.1).
Women and men are equally likely to develop hyponatremia and hyponatremic encephalopathy after surgery. However, when hyponatremic encephalopathy develops, menstruant women are about 25 times more likely to die or have permanent brain damage compared with either men or postmenopausal women.
确定术后低钠血症患者发生脑病及其临床病程的相关因素。
两家大学医学中心和社区医院的会诊及转诊服务。
病例对照研究（脑病的危险因素）和队列研究（脑病患者的临床病程）。
病例组包括65例术后低钠血症性脑病的成年患者；对照组包括674例术后发生低钠血症但无脑病的成年患者，这些患者选自76678例连续的成年外科住院患者。
年龄、性别、月经状况、神经症状、低钠血症发生时间及程度、动脉血气测定、血清化学指标、发病率和死亡率。
病例组包括40例女性（62%）和25例男性（38%）（P>0.05）；对照组包括367例女性（54%）和307例男性（46%）（P>0.1）。在34例发生永久性脑损伤或死亡的病例患者中，33例（97%）为女性（P<0.001）。在发生脑损伤的女性中，25例（76%）处于月经期（P<0.001）。与男性相比，女性因低钠血症性脑病死亡或发生永久性脑损伤的相对风险为28（95%CI，5至141）；与绝经后女性相比，处于月经期的女性为26（CI，11至62）。诊断时女性病例患者的动脉血氧分压显著低于男性病例患者（34±5与91±3mmHg；P<0.001）。此外，在38例诊断为低钠血症性脑病之前发生呼吸骤停的病例患者中，36例（95%）为女性。低钠血症的程度或发生时间与随后的脑损伤无关（P>0.1）。
术后女性和男性发生低钠血症及低钠血症性脑病的可能性相同。然而，当发生低钠血症性脑病时，与男性或绝经后女性相比，处于月经期的女性死亡或发生永久性脑损伤的可能性约高25倍。
