危重症患者血钠紊乱的危险因素及治疗策略分析

Analyzing the Risk Factors and Therapeutic Strategies for Blood Sodium Disorders in Critically Ill Patients

摘要: 入住重症监护病房的患者病情危重，常引起水、电解质代谢功能紊乱，从而导致体液容量、分布、电解质浓度变化，其最常见的是血钠水平紊乱，包括低钠血症、高钠血症，其中低钠血症发病率更高。低钠血症被定义为血清钠水平 < 135 mmol/L，可由心力衰竭、肝硬化、抗利尿激素分泌异常综合征等疾病导致。高钠血症被定义为血清钠水平 > 145 mmol/L，可由烧伤、高热、呕吐、腹泻等疾病引起。在临床治疗中不恰当的治疗方案也可产生不良预后影响，同时血钠紊乱也是危重症患者死亡率增加的重要危险因素。本文从血钠水平紊乱的诊断标准、分类、病理生理机制及治疗策略等方面进行综述，以期提高临床医生对血钠紊乱的认识，及时合理地处理血钠紊乱疾病，减少患者不良预后产生。

Abstract: Water and electrolyte metabolism is often affected by the critical condition of patients admitted to the intensive care unit, which leads to changes in body fluid volume, distribution, and electrolyte concentration, and the most common of which is disorders in blood sodium levels, including hypo-natremia and hypernatremia, with a higher incidence of hyponatremia. Hyponatremia was defined as a serum sodium level < 135 mmol/L and can be caused by conditions such as heart failure, cir-rhosis of the liver, and syndrome of abnormal secretion of antidiuretic hormone. Hypernatremia is a condition that results from a serum sodium level above 145 mmol/L and can be caused by condi-tions like burns, high fever, vomiting, and diarrhea. Inappropriate therapeutic programs in clinical treatment can also have adverse prognostic effects, and at the same time, the blood sodium disor-der is also an important risk factor for increased mortality in critically ill patients. This article re-views the diagnostic criteria, classification, pathophysiological mechanisms, and treatment strate-gies of sodium disorders in order to improve clinicians’ understanding of sodium disorders, to deal with sodium disorders in a timely and reasonable manner, and to reduce the adverse prognosis of patients.