Padhi Rajesh, Panda Baikuntha Nath, Jagati Snehalata, Patra Subhas Chandra
Department of Medicine, Division of Critical Care, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India.
Department of Anaesthesia, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India.
Indian J Crit Care Med. 2014 Feb;18(2):83-7. doi: 10.4103/0972-5229.126077.
Hyponatremia is a common electrolyte disturbance in critically ill hence understanding its implications is important.
This study was carried out to ascertain frequency, predisposing conditions and outcome in critically ill patients with hyponatremia on intensive care unit (ICU) admission.
This was an observational, prospective study of a series of ICU patients during a 12-month period.
THE PATIENTS WERE DIVIDED INTO TWO GROUPS: Hyponatremic (serum sodium < 135 mmol/L) and Eunatremic groups (135-145 mmol/L). Clinical examination included volume status and drug history, biochemistries, clinical diagnosis and cause of hyponatremia.
Fisher's exact test, unpaired t-tests Wilcoxon ranksum tests, profile-likelihood method, log-rank test and Kaplan-Meier curves were used. P < 0.05 were considered to be statistically significant.
In the hyponatremic group, the frequency of hyponatremia on ICU admission was 34.3%, most were euvolumic, 58.96%. Females comprised of 36.5%. The mean age was 60.4 ± 17.2. The Syndrome of inappropriate Antidiuretic Hormone (SIADH) criteria was met in ninety-one patients (36.25%), peumonia being the leading cause of SIADH. Patients with severe sepsis, elective surgery patients, renal failure and heart failure, cirrhosis of liver and subarachnoid hemorrhage were other more likely etiologic causes (P < 0.05). The hyponatremic group spent a longer time in the ICU (P = 0.02), had longer mechanical ventilator days (P < 0.05) and had an increased mortality rate (P = 0.01).
Hyponatremia present on admission to the ICU is independent risk factors for poor prognosis.
低钠血症是危重症患者常见的电解质紊乱，因此了解其影响很重要。
本研究旨在确定重症监护病房（ICU）收治的低钠血症危重症患者的发生率、诱发因素及预后情况。
这是一项对一系列ICU患者进行的为期12个月的观察性前瞻性研究。
患者分为两组：低钠血症组（血清钠<135 mmol/L）和血钠正常组（135 - 145 mmol/L）。临床检查包括容量状态、用药史、生化指标、临床诊断及低钠血症病因。
采用Fisher精确检验、非配对t检验、Wilcoxon秩和检验、轮廓似然法、对数秩检验及Kaplan - Meier曲线。P < 0.05被认为具有统计学意义。
在低钠血症组中，ICU入院时低钠血症的发生率为34.3%，大多数为等容性，占58.96%。女性占36.5%。平均年龄为60.4±17.2岁。91例患者（36.2%）符合抗利尿激素分泌异常综合征（SIADH）标准，肺炎是SIADH的主要原因。严重脓毒症患者、择期手术患者、肾衰竭和心力衰竭患者、肝硬化和蛛网膜下腔出血患者是其他更可能的病因（P < 0.05）。低钠血症组在ICU的住院时间更长（P = 0.02），机械通气天数更长（P < 0.05），死亡率更高（P = 0.01）。
ICU入院时存在的低钠血症是预后不良的独立危险因素。
