Department of Critical Care Medicine, University of Calgary, Foothills Medical Centre, Canada.
Can J Anaesth. 2010 Jul;57(7):650-8. doi: 10.1007/s12630-010-9309-1. Epub 2010 Apr 20.
Although intensive care unit (ICU) acquired sodium disturbances are common in critically ill patients, few studies have examined sodium disturbances in patients following cardiac surgery. The objective of this study was to describe the epidemiology of ICU-acquired hyponatremia and hypernatremia in patients following cardiac surgery.
We identified 6,727 adults (> or =18 yr) who were admitted consecutively to a regional cardiovascular intensive care unit (CVICU) from January 1, 2000 to December 31, 2006 and were documented as having normal serum sodium levels (133 to 145 mmol.L(-1)) during the first day of ICU admission. ICU-acquired hyponatremia and hypernatremia were defined as a change in serum sodium concentration to <133 mmol.L(-1) or >145 mmol.L(-1), respectively, following ICU day one.
A first episode of ICU-acquired hyponatremia and hypernatremia developed in 785 (12%) and 242 (4%) patients, respectively, (95% confidence interval [CI] 11-12% and 95% CI 3-4%, respectively), with a respective incidence density of 4.2 and 1.3 patients per 100 days of ICU admission (95% CI 4.0-4.5 and 95% CI 1.2-1.5). The incidence of ICU-acquired sodium disturbances varied according to the patients' demographic and clinical variables for both hyponatremia (age, diabetes, Acute Physiology and Chronic Health Evaluation [APACHE II] score, mechanical ventilation, length of ICU stay, serum glucose level, and serum potassium level) and hypernatremia (APACHE II score, mechanical ventilation, length of hospital stay prior to ICU admission, length of ICU stay, serum glucose level, and serum potassium level). Compared with patients with normal serum sodium levels, hospital mortality was increased in patients with ICU-acquired hyponatremia (1.6% vs 10%, respectively; P < 0.001) and ICU-acquired hypernatremia (1.6% vs 14%, respectively; P < 0.001).
ICU-acquired hyponatremia and hypernatremia are common complications in critically ill patients following cardiac surgery. They are associated with patient demographic and clinical characteristics and an increased risk of hospital mortality.
尽管 ICU 获得性钠紊乱在危重病患者中很常见，但很少有研究检查心脏手术后患者的钠紊乱。本研究的目的是描述心脏手术后 ICU 获得性低钠血症和高钠血症的流行病学。
我们确定了 2000 年 1 月 1 日至 2006 年 12 月 31 日连续入住区域性心血管 ICU（CVICU）的 6727 名成年人（>或=18 岁），并且在 ICU 入院的第一天记录血清钠水平正常（133 至 145mmol/L）。ICU 获得性低钠血症和高钠血症定义为 ICU 入院后第一天血清钠浓度分别降至<133mmol/L 或>145mmol/L。
785 名（12%）和 242 名（4%）患者分别出现首次 ICU 获得性低钠血症和高钠血症（95%置信区间 [CI] 11-12%和 95% CI 3-4%），相应的 ICU 入院后 100 天发病率密度分别为 4.2 和 1.3 例/100 天（95% CI 4.0-4.5 和 95% CI 1.2-1.5）。ICU 获得性钠紊乱的发生率因患者的人口统计学和临床变量而有所不同，包括低钠血症（年龄、糖尿病、急性生理学和慢性健康评估 [APACHE II]评分、机械通气、ICU 住院时间、血清葡萄糖水平和血清钾水平）和高钠血症（APACHE II 评分、机械通气、ICU 入院前住院时间、ICU 住院时间、血清葡萄糖水平和血清钾水平）。与血清钠水平正常的患者相比，ICU 获得性低钠血症（分别为 1.6%和 10%，P<0.001）和 ICU 获得性高钠血症（分别为 1.6%和 14%，P<0.001）患者的住院死亡率增加。
心脏手术后 ICU 获得性低钠血症和高钠血症是危重病患者的常见并发症。它们与患者的人口统计学和临床特征以及住院死亡率增加有关。
