Division of Cardiac Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH 43210, USA.
J Surg Res. 2013 May 1;181(1):60-6. doi: 10.1016/j.jss.2012.06.004. Epub 2012 Jun 22.
To study the effect of preoperative hyponatremia (Na <135 mEq/L) on outcomes after cardiac surgery.
From 2002 to 2008, 4370 patients had cardiac surgery at our institution (CABG in 2238, valve in 597, CABG valve in 537, other in 998). The institution electronic medical records, STS database, and Social Security death index data were analyzed. The association of hyponatremia with mortality, hospital length of stay (LOS), and complications was analyzed using regression analysis.
Prevalence of hyponatremia was 21%. Patients with preoperative hyponatremia had lower left ventricular ejection fraction (39% ± 17% versus 46% ± 14%, P < 0.001) and glomerular filtration rate (69 ± 32 mg/min/1.73 m(2)versus 74 ± 27 mg/min/1.73 m(2), P < 0.001) and higher median EuroSCORE (19% versus 9%, P < 0.001), NYHA class 3-4 (77% versus 65%, P < 0.001), prevalence of chronic obstructive pulmonary disease (25% versus 18%, P < 0.001), and arteriopathy (20% versus 13%, P < 0.001). Hyponatremia was associated with increased early mortality (9% versus 4%, P < 0.001), late mortality (24% versus 16%, P < 0.001), and LOS (13 versus 8 d, P < 0.001). Mortality increased with the severity of hyponatremia. After adjusting for baseline and operative variables, hyponatremia was associated with increased hazard of mortality (hazard ratio [HR] 1.31, 95% confidence interval [CI] 1.14-1.52, P < 0.001), risk of early mortality (odds ratio [OR] 1.52, 95% CI 1.09-2.12, P < 0.001), late mortality (HR 1.37, 95% CI 1.16-1.62, P < 0.001), LOS (multiplier 1.26, 95% CI 1.15-1.39, P < 0.001), operative complications (OR 1.30, 95% CI 1.00-1.69, P = 0.051), and dialysis (OR 1.64, 95% CI 1.11-2.44, P = 0.013).
Preoperative hyponatremia is common, especially in high-risk patients. It is an independent risk factor for mortality, prolonged hospitalization, and complications after cardiac surgery.
研究术前低钠血症（Na < 135 mEq/L）对心脏手术后结局的影响。
2002 年至 2008 年，我院共进行了 4370 例心脏手术（CABG 2238 例，瓣膜 597 例，CABG 瓣膜 537 例，其他 998 例）。分析机构电子病历、STS 数据库和社会保障死亡指数数据。使用回归分析分析低钠血症与死亡率、住院时间（LOS）和并发症的关系。
低钠血症的患病率为 21%。术前低钠血症患者的左心室射血分数（39% ± 17% 与 46% ± 14%，P < 0.001）和肾小球滤过率（69 ± 32 mg/min/1.73 m2 与 74 ± 27 mg/min/1.73 m2，P < 0.001）较低，欧洲危重病评分中位数（19% 与 9%，P < 0.001）、NYHA 分级 3-4 级（77% 与 65%，P < 0.001）、慢性阻塞性肺病（25% 与 18%，P < 0.001）和动脉病（20% 与 13%，P < 0.001）发生率较高。低钠血症与早期死亡率（9% 与 4%，P < 0.001）、晚期死亡率（24% 与 16%，P < 0.001）和 LOS（13 天与 8 天，P < 0.001）增加有关。死亡率随低钠血症的严重程度而增加。在校正基线和手术变量后，低钠血症与死亡风险增加相关（风险比[HR] 1.31，95%置信区间[CI] 1.14-1.52，P < 0.001），早期死亡风险（比值比[OR] 1.52，95%CI 1.09-2.12，P < 0.001），晚期死亡率（HR 1.37，95%CI 1.16-1.62，P < 0.001），LOS（乘数 1.26，95%CI 1.15-1.39，P < 0.001），手术并发症（OR 1.30，95%CI 1.00-1.69，P = 0.051）和透析（OR 1.64，95%CI 1.11-2.44，P = 0.013）。
术前低钠血症很常见，尤其是高危患者。它是心脏手术后死亡率、住院时间延长和并发症的独立危险因素。
