Wang Geng Huan, Yan Yu, Shen He Ping, Chu Zhengmin
Department of Neurosurgery, the Second Affiliated Hospital of Jiaxing University, Jiaxing, China.
Zhejiang University of Traditional Chinese Medicine, Hongzhou, China.
J Korean Neurosurg Soc. 2023 May;66(3):332-339. doi: 10.3340/jkns.2022.0078. Epub 2022 Oct 13.
The present study aimed to investigate the clinical characteristics of electrolyte imbalance in patients with moderate to severe traumatic brain injury (TBI) who underwent craniotomy and its influence on prognosis.
A total of 156 patients with moderate to severe TBI were prospectively collected from June 2019 to June 2021. All patients underwent craniotomy and intracranial pressure (ICP) monitoring. We aimed to explore the clinical characteristics of electrolyte disturbance and to analyze the influence of electrolyte disturbance on prognosis.
A total of 156 patients with moderate and severe TBI were included. There were 57 cases of hypernatremia, accounting for 36.538%, with the average level of 155.788±7.686 mmol/L, which occurred 2.2±0.3 days after injury. There were 25 cases of hyponatremia, accounting for 16.026%, with the average level of 131.204±3.708 mmol/L, which occurred 10.2±3.3 days after injury. There were three cases of hyperkalemia, accounting for 1.923%, with the average level of 7.140±1.297 mmol/L, which occurred 5.3±0.2 days after injury. There were 75 cases of hypokalemia, accounting for 48.077%, with the average level of 3.071±0.302 mmol/L, which occurred 1.8±0.6 days after injury. There were 105 cases of hypocalcemia, accounting for 67.308%, with the average level of 1.846±0.104 mmol/L, which occurred 1.6±0.2 days after injury. There were 17 cases of hypermagnesemia, accounting for 10.897%, with the average level of 1.213±0.426 mmol/L, which occurred 1.8±0.5 days after injury. There were 99 cases of hypomagnesemia, accounting for 63.462%, with the average level of 0.652±0.061 mmol/L, which occurred 1.3±0.4 days after injury. Univariate regression analysis revealed that age, Glasgow coma scale (GCS) score at admission, pupil changes, ICP, hypernatremia, hypocalcemia, hypernatremia combined with hypocalcemia, epilepsy, cerebral infarction, severe hypoproteinemia were statistically abnormal (p<0.05), while gender, hyponatremia, potassium, magnesium, intracranial infection, pneumonia, allogeneic blood transfusion, hypertension, diabetes, abnormal liver function, and abnormal renal function were not statistically significant (p>0.05). After adjusting gender, age, GCS, pupil changes, ICP, epilepsy, cerebral infarction, severe hypoproteinemia, multivariate logistic regression analysis revealed that hypernatremia or hypocalcemia was not statistically significant, while hypernatremia combined with hypocalcemia was statistically significant (p<0.05).
The incidence of hypocalcemia was the highest, followed by hypomagnesemia, hypokalemia, hypernatremia, hyponatremia and hypermagnesemia. Hypocalcemia, hypomagnesemia, and hypokalemia generally occurred in the early post-TBI period, hypernatremia occurred in the peak period of ICP, and hyponatremia mostly occurred in the late period after decreased ICP. Hypernatremia combined with hypocalcemia was associated with prognosis.
本研究旨在探讨接受开颅手术的中重度创伤性脑损伤（TBI）患者电解质失衡的临床特征及其对预后的影响。
前瞻性收集2019年6月至2021年6月期间共156例中重度TBI患者。所有患者均接受开颅手术及颅内压（ICP）监测。我们旨在探究电解质紊乱的临床特征，并分析电解质紊乱对预后的影响。
共纳入156例中重度TBI患者。高钠血症57例，占36.538%，平均水平为155.788±7.686 mmol/L，于伤后2.2±0.3天出现。低钠血症25例，占16.026%，平均水平为131.204±3.708 mmol/L，于伤后10.2±3.3天出现。高钾血症3例，占1.923%，平均水平为7.140±1.297 mmol/L，于伤后5.3±0.2天出现。低钾血症75例，占48.077%，平均水平为3.071±0.302 mmol/L，于伤后1.8±0.6天出现。低钙血症105例，占67.308%，平均水平为1.846±0.104 mmol/L，于伤后1.6±0.2天出现。高镁血症17例，占10.897%，平均水平为1.21√3±0.426 mmol/L，于伤后1.8±0.5天出现。低镁血症99例，占63.462%，平均水平为0.652±0.061 mmol/L，于伤后1.3±0.4天出现。单因素回归分析显示，年龄、入院时格拉斯哥昏迷量表（GCS）评分、瞳孔变化、ICP、高钠血症、低钙血症、高钠血症合并低钙血症、癫痫、脑梗死、重度低蛋白血症差异有统计学意义（p<0.05），而性别、低钠血症、钾、镁、颅内感染、肺炎、异体输血、高血压、糖尿病、肝功能异常及肾功能异常差异无统计学意义（p>0.05）。在调整性别、年龄、GCS、瞳孔变化、ICP、癫痫、脑梗死、重度低蛋白血症后，多因素logistic回归分析显示，高钠血症或低钙血症差异无统计学意义，而高钠血症合并低钙血症差异有统计学意义（p<0.05）。
低钙血症发生率最高，其次为低镁血症、低钾血症、高钠血症、低钠血症和高镁血症。低钙血症、低镁血症和低钾血症一般发生在TBI后早期，高钠血症发生在ICP高峰期，低钠血症大多发生在ICP下降后的后期。高钠血症合并低钙血症与预后相关。
