Division of Cardiac Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH, USA.
J Am Coll Surg. 2013 Jun;216(6):1135-43, 1143.e1. doi: 10.1016/j.jamcollsurg.2013.02.010. Epub 2013 Apr 23.
The association between postoperative hyponatremia (Na < 135 mEq/L) and outcomes after cardiac surgery has not been established. We studied the prevalence of postoperative hyponatremia and its effects on outcomes after cardiac surgery.
We studied 4,850 patients who underwent cardiac surgery from 2002 to 2008. We used multivariable logistic and Cox regression analysis to study the association between postoperative hyponatremia and mortality, length of hospital stay (LOS), and complications.
Postoperative hyponatremia was present in 59%. Hyponatremic patients were older (mean ± SD, 62 ± 13 vs 61 ± 14 years, p = 0.001), had lower left ventricle ejection fraction (mean ± SD, 44% ± 16% vs 48% ± 13%, p < 0.001), higher mean pulmonary artery pressures (mean ± SD, 30 ± 11 vs 27 ± 9 mmHg, p < 0.001), lower glomerular filtration rate (mean ± SD, 72 ± 29 vs 74 ± 27 mg/min/1.73 m(2), p = 0.01), higher EuroSCORE (median, 15% vs 6%, p < 0.001), higher New York Heart Association class IV (31% vs 26%, p = 0.002), prevalence of COPD (23% vs 14%, p < 0.001), and peripheral vascular disease (16% vs 12%, p < 0.001). Hyponatremia increased overall (24% vs 18.2%, p < 0.001) and late mortality (18.6% vs 13.9%, p < 0.001) and length of stay (LOS; 11 vs 7 days, p < 0.001). Mortality increased with the severity of the hyponatremia. After adjusting for baseline and procedure variables, postoperative hyponatremia was associated with increase in mortality (hazard ratio 1.22, 95% CI 1.06-1.4, p = 0.004), LOS (multiplier 1.34, 95% CI 1.22-1.49, p < 0.001), infectious (odds ratio [OR] 2.32, 95% CI 1.48-3.62, p < 0.001), pulmonary (OR 1.82, 95% CI 1.49-2.21, p < 0.001), and renal failure complications (OR 2.46, 95% CI 1.58-3.81, p < 0.001) and need for dialysis (OR 3.66, 95% CI 1.72-7.79, p = 0.001).
Hyponatremia is common after cardiac surgery and is an independent predictor of increased mortality, length of hospital stay, and postoperative complications.
心脏手术后低钠血症（血清钠<135mEq/L）与术后结局之间的关系尚未确定。我们研究了心脏手术后低钠血症的发生率及其对术后结局的影响。
我们研究了 2002 年至 2008 年间接受心脏手术的 4850 例患者。我们使用多变量逻辑和 Cox 回归分析来研究术后低钠血症与死亡率、住院时间（LOS）和并发症之间的关系。
低钠血症发生率为 59%。低钠血症患者年龄较大（平均±标准差，62±13 岁比 61±14 岁，p=0.001），左心室射血分数较低（平均±标准差，44%±16%比 48%±13%，p<0.001），平均肺动脉压较高（平均±标准差，30±11 毫米汞柱比 27±9 毫米汞柱，p<0.001），肾小球滤过率较低（平均±标准差，72±29 毫克/分钟/1.73m²比 74±27 毫克/分钟/1.73m²，p=0.01），EuroSCORE 较高（中位数，15%比 6%，p<0.001），纽约心脏协会心功能分级Ⅳ级较多（31%比 26%，p=0.002），COPD 患病率较高（23%比 14%，p<0.001），外周血管疾病较多（16%比 12%，p<0.001）。低钠血症患者的总死亡率（24%比 18.2%，p<0.001）和晚期死亡率（18.6%比 13.9%，p<0.001）以及住院时间（LOS；11 天比 7 天，p<0.001）均升高。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，术后低钠血症与死亡率增加相关（风险比 1.22，95%置信区间 1.06-1.4，p=0.004），LOS（乘数 1.34，95%置信区间 1.22-1.49，p<0.001），感染（比值比 [OR] 2.32，95%置信区间 1.48-3.62，p<0.001），肺部（OR 1.82，95%置信区间 1.49-2.21，p<0.001），和肾功能衰竭并发症（OR 2.46，95%置信区间 1.58-3.81，p<0.001）以及需要透析（OR 3.66，95%置信区间 1.72-7.79，p=0.001）。
心脏手术后低钠血症很常见，是死亡率、住院时间和术后并发症增加的独立预测因素。
