入院时低钠血症与髋部骨折患者院内死亡相关。
Hyponatremia at admission is associated with in-hospital death in patients with hip fracture.
机构信息
Department of Orthopaedic Surgery, National Hospital Organization, Kofu National Hospital, 11-35 Tenjin-cho, Kofu, Yamanashi, Japan.
出版信息
Arch Orthop Trauma Surg. 2013 Apr;133(4):507-11. doi: 10.1007/s00402-013-1693-x. Epub 2013 Feb 15.
PURPOSE
Hyponatremia in hospitalized patients has been reported to be associated with in-hospital mortality. We studied patients treated at our hospital for hip fracture regarding the factors related to hyponatremia at admission.
METHODS
Among 580 patients aged 60 years or above who were admitted to our hospital since January 1997 for treatment of hip fracture, 512 patients (110 males, 402 females) from whom serum sodium level at admission was available were studied. In 512 patients, the age at injury ranged from 60 to 103 (mean 82.6) years. Fracture types were femoral neck fracture in 191 patients, and trochanteric fracture in 321. These patients were divided into two groups by the blood sodium level at admission: a hyponatremia group with sodium levels lower than 135 mEq/L, and a normonatremia group with sodium levels within normal range. The age, gender, fracture type, residence before injury, pre-injury walking capability, anemia at admission, liver function, kidney function, inflammatory status, urinary glucose status, lung disease, ECG abnormality, systemic chronic disease, status of dementia, treatment modality, hospital stay (days), and in-hospital death were investigated. First a univariate study was conducted to identify the factors that differ significantly between the two groups. Then multivariate analysis was conducted using the parameters with significant difference as independent variables
RESULTS
Hyponatremia was found in 49 of 512 (9.6 %) patients. In univariate analyses, six factors (age; residence before injury; anemia; dementia; treatment modality; in-hospital death) were significantly different between the hyponatremia group and normonatremia group. Multivariate analysis identified in-hospital death [odds ratio (OR) = 3.64, p = 0.035] and age (OR = 1.05, p = 0.029) as independently associated with hypernatremia.
CONCLUSION
Hyponatremia at admission is prevalent in old aged patients with fracture, and is related to in-hospital death.
目的
有报道称，住院患者的低钠血症与院内死亡率有关。我们研究了在我院接受治疗的髋部骨折患者，以了解入院时低钠血症相关的因素。
方法
1997 年 1 月以来，我院共收治 580 例年龄 60 岁及以上的髋部骨折患者，其中 512 例（男 110 例，女 402 例）入院时血清钠水平可查。512 例患者年龄 60~103 岁，平均 82.6 岁。骨折类型：股骨颈骨折 191 例，转子间骨折 321 例。这些患者根据入院时的血钠水平分为两组：血钠水平低于 135 mEq/L 的低钠血症组和血钠水平正常的正常钠血症组。记录年龄、性别、骨折类型、入院前居住地、入院前行走能力、入院时贫血、肝功能、肾功能、炎症状态、尿糖状态、肺部疾病、心电图异常、全身性慢性疾病、痴呆状态、治疗方式、住院时间（天）和院内死亡情况。首先进行单因素分析，确定两组间有显著差异的因素。然后将有显著差异的参数作为自变量进行多因素分析。
结果
512 例患者中 49 例（9.6%）存在低钠血症。单因素分析显示，低钠血症组与正常钠血症组在 6 个因素（年龄、入院前居住地、贫血、痴呆、治疗方式、院内死亡）上有显著差异。多因素分析显示，院内死亡（比值比[OR] = 3.64，p = 0.035）和年龄（OR = 1.05，p = 0.029）与低钠血症独立相关。
结论
髋部骨折老年患者入院时低钠血症较为常见，与院内死亡有关。
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