摘要
目的经口寰枢椎复位钢板(transoral atlantoaxial reductionplate,TARP)手术针对传统术式难于解决的寰枢椎病变,尤其是难复性寰枢椎脱位等疾病,临床上取得了满意的疗效,但术后有时会合并严重低钠血症,影响手术效果,甚至威胁患者生命,文中探讨TARP内固定手术患者术后合并重度低钠血症(severe hyponatremia,SH)的危险因素,为临床上预防TARP术后严重低钠血症的发生提供理论依据。方法收集219例行TARP手术患者的临床资料,根据术后合并低钠血症程度,分为SH组和非重度低钠血症(non severe hyponatremia,NSH)组。比较2组患者围术期观察项目的差异性,单因素分析采用t检验或χ2检验,多因素分析采用Logistic回归分析。结果 21例(9.6%)患者术后发生SH,单因素分析发现脊髓损伤程度(Frankle分级)、机械通气、低蛋白血症(血清清蛋白<35 g/L)、气管导管留置时间、手术时间、气管切开、术前低体重指数(body mass index,BMI,<18.5)、术后消化功能紊乱及合并有肺部感染与TARP手术患者术后SH相关;Logistic多因素回归分析发现只有脊髓损伤程度(Frankle分级)、低蛋白血症(血清清蛋白<35g/L)及合并有肺部感染为独立危险因素。结论对于TARP手术患者,其脊髓损伤程度(Frankle分级)、术后消化功能紊乱、低蛋白血症及合并肺部感染为术后发生SH的重要影响因素。
Objective Satisfactory results have been achieved in applying the transoral atlantoaxial reduction plate （TARP） fixation to the surgical treatment of atlantoaxial lesions, which frequently fails to respond to conventional procedures. However, severe hyponatremia （SH） may occur postoperatively, which may affect surgical outcomes and even threaten the life of the patient. This study was to investigate the risk factors of SH in patients following TARP surgery. Methods Based on the severity of postoperative SH, we divided 219 patients treated by TARP surgery into an SH and a non-SH group, and analyzed 13 perioperative variables of the patients using T test, chi-square test and logistic regression analysis. Results SH occurred in 9.6% （21/219） of the patients following TARP surgery. Univariate analysis showed that postoperative SH was correlated with the Frankle grade, mechanical ventilation, hy- poproteinemia, intubation duration, operation time, tracheotomy, lower body mass index （ 〈 18.5）, digestive disturbance and pulmo- nary infection. Multivariate logistic regression analysis identified 4 independent risk factors of SH, which were the Frankle grade, di- gestive disturbance, hypoproteinemia and pulmonary infection. Conclusion The Frankle grade, digestive disturbance, hypopro- teinemia and pulmonary infection are important influential factors of hyponatremia following TARP surgery.
出处
《医学研究生学报》
CAS
北大核心
2013年第11期1175-1177,共3页
Journal of Medical Postgraduates
