Svaninger G, Nordgren S, Palselius I R, Fasth S, Hultén L
Department of Surgery II, Sahlgrenska sjukhuset, University of Göteborg, Sweden.
Eur J Surg. 1991 Oct;157(10):601-5.
The output of sodium and potassium from urine and ileostomy was investigated in 35 healthy patients with ileostomies; 17 had undergone proctocolectomy for ulcerative colitis and 18 for Crohn's colitis. Fifteen of the patients with Crohn's disease had also had small bowel resections, varying from 15 to 46% of the original bowel length. The patients were investigated at home because most studies of sodium and water balance in patients with ileostomies have been done in hospital wards, which may not reflect actual conditions. Mean (SD) ileostomy output was 565 (152) ml in patients with ulcerative colitis and 1,267 (540) ml in patients with Crohn's disease. The intrapatient variation was limited, whereas the interpatient variation was significant and correlated with the length of small bowel resected. The sodium concentration in the ileostomy discharge was 110 (9.2) mmol/l and did not change consistently with ileostomy volume. The potassium concentration was 10 (2.1) mmol/l. There was a significant inverse correlation between daily ileostomy sodium output and urinary sodium concentration (r = -0.44, p less than 0.01), and a significant correlation between the daily output of sodium in ileostomy contents and the sodium:potassium ratio in urine. We conclude that patients with ileostomies are at risk of sodium and water depletion, particularly those who have had small bowel resections. Increased sodium output from the ileostomy is associated with a reduction in the sodium:potassium ratio in the urine. To screen patients at risk, an estimate of the sodium balance can be made by measuring sodium and potassium concentrations in a single specimen of urine.
对35例健康回肠造口患者的尿液和回肠造口钠、钾排出量进行了研究；其中17例因溃疡性结肠炎接受了直肠结肠切除术，18例因克罗恩氏结肠炎接受了该手术。15例克罗恩病患者还进行了小肠切除术，切除长度占原肠长的15%至46%不等。对这些患者进行了居家调查，因为此前大多数关于回肠造口患者钠和水平衡的研究都是在医院病房进行的，而这可能无法反映实际情况。溃疡性结肠炎患者回肠造口的平均（标准差）排出量为565（152）毫升，克罗恩病患者为1267（540）毫升。患者个体内差异有限，而个体间差异显著，且与小肠切除长度相关。回肠造口排泄物中的钠浓度为110（9.2）毫摩尔/升，并不随回肠造口排出量持续变化。钾浓度为10（2.1）毫摩尔/升。回肠造口每日钠排出量与尿钠浓度之间存在显著负相关（r = -0.44，p < 0.01），回肠造口内容物中钠的每日排出量与尿中钠钾比之间存在显著正相关。我们得出结论，回肠造口患者有钠和水耗竭的风险，尤其是那些接受过小肠切除术的患者。回肠造口钠排出量增加与尿中钠钾比降低有关。为筛查有风险的患者，可通过测量单次尿液样本中的钠和钾浓度来评估钠平衡。
