住院儿童维持液治疗后低钠血症发生情况及影响因素研究

doi:10.12183/j.scjpm.2023.0421

华南预防医学 ›› 2023, Vol. 49 ›› Issue (4): 421-426.doi: 10.12183/j.scjpm.2023.0421

住院儿童维持液治疗后低钠血症发生情况及影响因素研究

谢国强^1,2, 任广立^1,2

1.南方医科大学第一临床医学院,广东广州 510515;
2.中国人民解放军南部战区总医院

收稿日期:2023-01-30 出版日期:2023-04-20 发布日期:2023-07-06
通讯作者: 任广立,E‐mail：guangliren@hotmail.com
作者简介:谢国强（1990—）,男,在读硕士研究生,主治医师,主要研究方向为儿童重症
基金资助:
南部战区总医院II类课题（2021NZC022）; 军队科技面上项目（CLB20J032）

Incidence and influencing factors of hyponatremia in hospitalized children after maintenance solution treatment

XIE Guoqiang^1,2, REN Guangli^1,2

1. The First School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China;
2. General Hospital of Southern Theater Command of PLA

Received:2023-01-30 Online:2023-04-20 Published:2023-07-06

摘要/Abstract

摘要： 目的研究住院儿童维持液治疗后低钠血症的发生情况,并分析影响儿童低钠血症发生的相关因素。方法采用前瞻性、观察性研究方法,纳入2021年1月至2023年1月在南部战区总医院住院,需要至少24 h且超过1/2生理需要量静脉维持液治疗的儿童,收集基线资料、临床指标和检验指标,分析低钠血症发生情况及其影响因素。结果共纳入111例住院儿童,其中中枢神经系统疾病40例、呼吸系统疾病14例、消化道疾病25例、血液肿瘤疾病20例、脓毒症/全身炎症反应综合征12例。低钠血症发生率为27.9%（31/111）,其中轻度低钠血症为23.4%（26/111）,中度低钠血症为4.5%（5/111）。多因素Logistic回归分析显示,较高的和肽素水平（中水平OR=146.528,高水平OR=524.775）、病重/病危状态（OR=7.732）是低钠血症发生的危险因素,较高的液体总张力（1/2~3/4张OR=0.014,≥3/4张OR=0.004）是低钠血症发生的保护因素。列联表分析显示,低和肽素水平或者输注较高张力维持液（≥1/2张）的患儿低钠血症发生率较低,分别为1.8%（1/56）、6.3%（2/32）。结论需超过24 h维持液治疗的住院儿童低钠血症发生率较高,建议使用较高张力维持液（液体总张力≥1/2张）,尤其是对高和肽素水平的儿童病例。

关键词: 儿童, 低钠血症, 液体张力, 抗利尿激素, 和肽素

Abstract: Objective To study the incidence of hyponatremia in hospitalized children after maintenance solution treatment and analyze the influencing factors on the occurrence of hyponatremia in children. Methods A prospective and observational study was conducted to include children hospitalized in the General Hospital of Southern Theater Command from January 2021 to January 2023 who needed at least 24 hours of intravenous maintenance solution with more than half of their physiological requirements. Baseline data, clinical indicators, and test indicators were collected to analyze the incidence of hyponatremia and its influencing factors. Results A total of 111 children were enrolled, including 40 cases of central nervous system disease, 14 cases of respiratory disease, 25 cases of gastrointestinal disease, 20 cases of hematological tumor diseases, and 12 cases of sepsis or systemic inflammatory response syndrome. The incidence of hyponatremia was 27.9% （31/111）, with mild hyponatremia being 23.4% （26/111） and moderate hyponatremia being 4.5% （5/111）。 Multivariate Logistic regression analysis showed that higher copeptin level （medium level OR=146.528, high level OR=524.775） and severity or critical ill state （OR=7.732） were risk factors for hyponatremia, while higher total solution tension （1/2-3/4 tension OR=0.014, ≥3/4 tension OR=0.004） was a protective factor for hyponatremia （all P<0.05）。 The contingency table analysis showed that the incidence of hyponatremia was lower in children with low level of copeptin or higher level of maintenance solution tension （≥1/2 tension）, which were 1.8% （1/56） and 6.3% （2/32）, respectively. Conclusion The incidence of hyponatremia is high in hospitalized children who require maintenance solution treatment for more than 24 hours, and the use of higher tension maintenance solution （total solution tension ≥1/2） is recommended, especially for children with high copeptin levels.

Key words: Children, Hyponatremia, Solution tension, Antidiuretic hormone, Copeptin

中图分类号:

R179

谢国强, 任广立. 住院儿童维持液治疗后低钠血症发生情况及影响因素研究[J]. 华南预防医学, 2023, 49(4): 421-426.

XIE Guoqiang, REN Guangli. Incidence and influencing factors of hyponatremia in hospitalized children after maintenance solution treatment[J]. South China Journal of Preventive Medicine, 2023, 49(4): 421-426.

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住院儿童维持液治疗后低钠血症发生情况及影响因素研究

Incidence and influencing factors of hyponatremia in hospitalized children after maintenance solution treatment

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