9870例老年住院患者血钠和血钾水平及其紊乱危险因素分析

摘要

目的 了解老年住院患者血钠、血钾失衡情况,并分析造成血钠、血钾失衡的危险因素.方法 回顾性分析,收集单中心老年住院患者血钠、血钾及危险因素资料,应用多因素回归分析方法分析血钠、血钾失衡发生率及造成电解质失衡的危险因素,并对血钠、血钾失衡纠正情况进行分析. 结果 本次收集9870例患者入院时及住院期间共发生6027次血钠、钾代谢紊乱,总体发生率61.6％;低钠血症、低钾血症、高钠血症及高钾血症发生率分别为2729次(27.9％)、1506次(15.4％)、951次(9.7％)及841次(8.6％);心功能不全是各种电解质紊乱的共同危险因素,糖尿病可造成低钠血症、低钾血症及高钠血症,药物因素中利尿剂是多种电解质紊乱的共同危险因素,而服用抗癫痫药、抗痴呆药、抗抑郁药及苯二氮(卓)类药物的患者更容易出现低钠血症;轻、中、重度低钠及低钾血症的纠正率分别为79.2％(1253/1582)、68.1％(535/786)、45.1％(163/361)及79.5％(776/976)、66.4％(217/327)、40.1％(81/203),纠正需要的时间分别为(3.4±2.7)d、(4.1±2.3)d、(8.9±1.6)d及(2.5±1.4)d、(3.2±1.5)d、(6.1±1.2)d,补充氯化钠的量分别为(5.98±3.67)g、(9.45±3.02)g、(10.26±1.32)g,补充氯化钾的量分别为(2.23±0.93)g、(5.12±1.53)g、(8.07±2.46)g.结论 老年住院患者因合并各种疾病及应用各种药物,电解质紊乱发生率较高,纠正困难,应受到关注和积极纠正.%Objective To investigate the sodium and potassium disturbances in 9870 elderly inpatients and to analyze their risk factors.Methods Clinical data of sodium and potassium levels and the possible risk factors were collected in the elderly inpatients from a single center.The incidence of sodium and potassium disturbances and their risk factors were analyzed by multiple Logistic regression,and the correction of the imbalance was investigated.Results A total of 6027(61.6％)times of sodium and potassium disturbances were found in the 9870 elderly inpatients on admission and during hospitalization,and the total incidence of this disturbances was 61.6％.The incidences of hyponatremia,hypokalemia,hypernatremia and hyperkalemia were 27.9％ (2729/6027),9.7％ (951/6027),15.4％(1506/6027) and 8.6％ (841/6027),respectively.Heart failure was the common risk factor for the two electrolyte disturbances.T2DM caused hyponatremia,hypokalemia and hypernatremia.Among the medication risk factors,diuretics were the common risk factor for various electrolyte disturbances.Patients taking antiepileptics,antidementia drugs,antidepressants and benzodiazepines were more likely to have hyponatremia.The correction rate of mild,moderate and severe hyponatremia/ hypokalemia were 79.2％(1253/1582),68.1％ (535/786),45.1％ (163/361) and 79.5％(776/976),66.4％(217/327),40.1％(81/203),respectively.The time for the correction of the above degrees of hyponatremia/ hypokalemia were(3.7±2.7) d,(4.1±2.3) d,(8.9±1.6) d and(2.5± 1.4) d,(3.2 ± 1.5) d,(6.1 ± 1.2) d.The supplement amounts of sodium chloride and potassium chloride were(5.98±3.67) g,(9.45±3.02) g,(10.26±1.32) g and(2.23±0.93) g,(5.12± 1.53) g,(8.07 ± 2.46) g,respectively.Conclusions The incidences of electrolyte disturbances are high in elderly inpatients with combined diseases and application of various drugs,and the correction of disturbances is difficult.More attention should be paid to the electrolyte disturbances,which should be corrected positively.