Macdonald N J, McConnell K N, Stephen M R, Dunnigan M G
Stobhill General Hospital, Glasgow.
BMJ. 1989 Dec 9;299(6713):1426-9. doi: 10.1136/bmj.299.6713.1426.
To determine the prevalence of hypernatraemic dehydration and to assess the hydration and nutritional state of patients in a large hospital for the mentally and physically handicapped; also to assess the efficacy of an intervention programme to reduce the prevalence of hypernatraemic dehydration in the hospital.
Prospective study of patients admitted with hypernatraemic dehydration from a large hospital for mentally and physically handicapped patients (hospital A) to a district general hospital between 1986 and 1988. In 1986 the hydration and nutritional state of a random sample of patients from hospital A was compared with a random sample of patients from a small hospital for the physically and mentally handicapped (hospital B) and with control groups from the community. The hydration of the patients from hospital A examined in 1986 was reassessed in 1988.
12 Patients were admitted from hospital A to the district general hospital during 1986-8 (seven women, five men; age range 29-82). In 1986, 72 patients were randomly selected for the assessment of hydration and nutritional state from hospital A, 33 who required help with feeding and 39 who could feed independently. Fifty patients were similarly selected from hospital B, half of them requiring help with feeding. In 1988 the hydration state of 60 of the 72 patients from hospital was reassessed. Control values were taken from two published studies.
In 1987 nursing staff in hospital A were asked to provide between 2.5 and 3.0 litres of fluid daily for all patients. The use of hypertonic enemas was discontinued, and the ratio of staff to patients was increased.
Serum concentrations of urea and electrolytes (hydration) and body mass index (nutritional state).
Of the 10 patients admitted with hypernatraemic dehydration from hospital A to the district general hospital in 1986, four died of intercurrent infection. No patients were admitted from hospital B with hypernatraemic dehydration during the same time. In 1986 the hydration and nutritional state of patients in hospital A were inferior to those in patients from hospital B and control subjects from the community (serum urea concentrations were 6.1 (SD 1.8) mmol/l v 5.5 (1.9) and 5.6 (0.4) mmol/l, respectively) 50% (36/72) of patients in hospital A had a body mass index less than or equal to 20 compared with 34% (17/50) of patients from hospital B and 12% (1141/9434) of control subjects). After the initiation of the preventive programme only one patient was admitted with hypernatraemic dehydration in each of the years 1987 and 1988. The mean serum urea concentration of the 60 patients who were reassessed in 1988 fell significantly between 1986 and 1988 from 6.1 (SD 1.8) mmol/l to 5.7 (2.1) mmol/l, the value in a control group matched for age and sex.
Hypernatraemic dehydration, subclinical underhydration, and undernutrition were common in a large hospital for the mentally and physically handicapped. The problem of hypernatraemic dehydration was successfully dealt with by the hospital management team. Similar problems may be encountered in hospitals for patients who are mentally and physically handicapped and mentally ill, including psychogeriatric units.
确定高钠血症性脱水的患病率，并评估一家大型身心障碍者医院中患者的水合状态和营养状况；同时评估一项干预计划在降低该医院高钠血症性脱水患病率方面的效果。
对1986年至1988年间从一家大型身心障碍者医院（A医院）收治到一家区综合医院的高钠血症性脱水患者进行前瞻性研究。1986年，将A医院患者的随机样本与一家小型身心障碍者医院（B医院）患者的随机样本以及社区对照组的水合状态和营养状况进行比较。1988年对1986年检查过的A医院患者的水合状态进行重新评估。
1986 - 1988年期间，有12名患者从A医院转入区综合医院（7名女性，5名男性；年龄范围29 - 82岁）。1986年，从A医院随机选取72名患者评估其水合状态和营养状况，其中33名需要喂食帮助，39名能够自主进食。从B医院类似地选取了50名患者，其中一半需要喂食帮助。1988年，对A医院72名患者中的60名的水合状态进行了重新评估。对照值取自两项已发表的研究。
1987年，要求A医院的护理人员为所有患者每日提供2.5至3.0升液体。停止使用高渗灌肠剂，并增加了医护人员与患者的比例。
血清尿素和电解质浓度（水合状态）以及体重指数（营养状况）。
1986年从A医院收治到区综合医院的10例高钠血症性脱水患者中，4例死于并发感染。同期B医院无高钠血症性脱水患者收治。1986年，A医院患者的水合状态和营养状况低于B医院患者及社区对照组（血清尿素浓度分别为6.1（标准差1.8）mmol/L、5.5（1.9）mmol/L和5.6（0.4）mmol/L）。A医院50%（36/72）的患者体重指数小于或等于20，而B医院为34%（17/50），社区对照组为12%（1141/9434）。预防计划实施后，1987年和1988年每年仅有1例高钠血症性脱水患者入院。1988年重新评估的60名患者的平均血清尿素浓度在1986年至1988年间从6.1（标准差1.8）mmol/L显著降至5.7（2.1）mmol/L，与年龄和性别匹配的对照组的值相同。
在一家大型身心障碍者医院中，高钠血症性脱水、亚临床脱水和营养不良情况常见。医院管理团队成功解决了高钠血症性脱水问题。在为身心障碍者和精神病患者（包括老年精神科病房）服务的医院中可能会遇到类似问题。
