Division of Perioperative Care, Box 93, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK
Division of Perioperative Care, Box 93, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK.
Br J Anaesth. 2015 Apr;114(4):615-22. doi: 10.1093/bja/aeu409. Epub 2014 Dec 12.
The perioperative period may be associated with a marked neurohumoral stress response, significant fluid losses, and varied fluid replacement regimes. Acute changes in serum sodium concentration are therefore common, but predictors and outcomes of these changes have not been investigated in a large surgical population.
We carried out a retrospective cohort analysis of 27 068 in-patient non-cardiac surgical procedures in a tertiary teaching hospital setting. Data on preoperative conditions, perioperative events, hospital length of stay, and mortality were collected, along with preoperative and postoperative serum sodium measurements up to 7 days after surgery. Logistic regression was used to investigate the association between sodium changes and mortality, and to identify clinical characteristics associated with a deviation from baseline sodium >5 mmol litre(-1).
Changes in sodium concentration >5 mmol litre(-1) were associated with increased mortality risk (adjusted odds ratio 1.49 for a decrease, 3.02 for an increase). Factors independently associated with a perioperative decrease in serum sodium concentration >5 mmol litre(-1) included age >60, diabetes mellitus, and the use of patient-controlled opioid analgesia. Factors associated with a similar increase were preoperative oxygen dependency, mechanical ventilation, central nervous system depression, non-elective surgery, and major operative haemorrhage.
Maximum deviation from preoperative serum sodium value is associated with increased hospital mortality in patients undergoing in-patient non-cardiac surgery. Specific preoperative and perioperative factors are associated with significant serum sodium changes.
围手术期可能与明显的神经体液应激反应、大量液体丢失和不同的液体替代方案有关。因此，血清钠浓度的急性变化很常见，但在大量手术人群中，尚未研究这些变化的预测因素和结果。
我们对一家三级教学医院的 27068 例非心脏住院手术进行了回顾性队列分析。收集了术前情况、围手术期事件、住院时间和死亡率的数据，以及术前和术后 7 天内的血清钠测量值。使用逻辑回归来研究钠变化与死亡率之间的关系，并确定与基线钠浓度偏离 >5 mmol/L 相关的临床特征。
钠浓度变化 >5 mmol/L 与死亡率增加相关（降低的调整比值比为 1.49，升高的为 3.02）。与术后血清钠浓度降低 >5 mmol/L 相关的独立因素包括年龄 >60 岁、糖尿病和使用患者自控镇痛。与类似增加相关的因素包括术前氧依赖、机械通气、中枢神经系统抑制、非择期手术和主要手术出血。
在接受非心脏住院手术的患者中，术前血清钠值的最大偏差与住院死亡率增加有关。特定的术前和围手术期因素与显著的血清钠变化相关。
