Department of Geriatrics, Rabin Medical Center, Beilinson Hospital, Sackler School of Medicine, Tel Aviv University, 39 Jabotinski St, Petah Tikva 49100, Israel.
Arch Gerontol Geriatr. 2011 Sep-Oct;53(2):179-82. doi: 10.1016/j.archger.2010.10.014. Epub 2010 Nov 9.
The aim of the study was to investigate Na(+)-course of hip fracture patients in relation to demographic and clinical parameters. Data on 155 older hip fracture patients were analyzed retrospectively. Clinical parameters and serum Na(+) on admission (Na1), during 24h pre-op. (Na2), during 24h post-op. (Na3), and pre-discharge (Na4) were recorded. Hyponatremia and hypernatremia rates pre- and post-operation were 26.5%, 2.6%, 24.5% and 5.8%. Higher Na3 (138.76 ± 4.4 mEq/l) vs. Na1 (137.69 ± 4.5 mEq/l) (p = 0.004) and correlation between age and Na3 (p = 0.021) was found. Mean serum Na(+) of impaired mental status (IMS) vs. normal patients and of partially/independent vs. dependent patients were higher (p < 0.05). More complications occurred in IMS patients tending to higher Na3 in patients with complications. No differences in Na(+)-courses were found according to sex or co-morbidities. Dysnatremia is highly prevalent in older hip fracture patients. A distinct post-operative increase in serum Na(+) was found, higher in the cognitively and functionally impaired patients. It seems that the Na(+) increase characterizes more IMS patients who suffer more complications, but does not necessarily indicate complications. We recommend surveillance of serum Na(+), particularly in cognitively and functionally impaired older patients in whom the risk of hypernatremia and complications is higher.
本研究旨在探讨髋部骨折患者的钠（Na+）变化与人口统计学和临床参数的关系。回顾性分析了 155 例老年髋部骨折患者的数据。记录了临床参数和入院时（Na1）、术前 24 小时内（Na2）、术后 24 小时内（Na3）和出院前（Na4）的血清 Na+。术前和术后低钠血症和高钠血症的发生率分别为 26.5%、2.6%、24.5%和 5.8%。发现术后 Na3（138.76±4.4 mEq/l）高于 Na1（137.69±4.5 mEq/l）（p=0.004），年龄与 Na3 之间存在相关性（p=0.021）。有认知障碍的患者（IMS）与正常患者相比，血清 Na+的平均值更高（p<0.05），部分/独立患者与依赖患者相比，血清 Na+的平均值更高（p<0.05）。IMS 患者并发症更多，Na3 值更高。性别或合并症与 Na+变化无差异。认知和功能障碍的患者 Na3 值更高。
老年髋部骨折患者中存在高发生率的低钠血症和高钠血症。术后血清 Na+明显升高，认知和功能障碍患者的 Na+升高更为明显。似乎 Na+升高的患者更容易发生 IMS，并发更多并发症，但这并不一定表明并发症的发生。我们建议监测血清 Na+，特别是在认知和功能障碍的老年患者中，这些患者发生高钠血症和并发症的风险更高。
