【摘要】 目的 评估重症监护病房（intensive care unit,ICU）获得性高钠血症（ICU-acquired hypernatremia,IAH）对脓毒症休克患者预后的影响。方法 本研究回顾性分析了2018年8月—2022年12月在苏州大学附属第一医院ICU收治的116例脓毒症休克患者。将患者分为两组：IAH组和正常血钠组。采用χ2检验、t检验及非参数检验中的Mann-Whitney U检验比较两组患者的临床资料的差异性；对危险因素进行非条件Logistic回归分析，找出导致IAH的独立危险因素，并构建其受试者工作特征（receiver operating characteristic,ROC）曲线，以确定其对IAH的预测作用；通过Kaplan-Meier曲线评估IAH及其持续天数对患者28 d存活率的影响。结果 两组患者中肾功能不全、K+浓度、热峰、机械通气、慢性危重病、快速恢复、脓毒症相关性脑病、持续性炎症–免疫抑制–分解代谢综合征和ICU住院时间具有统计学差异（P<0.05）。多因素logistic回归分析显示：前3 d总尿量[比值比（odds ratio,OR） 1.09,95%可信区间（confidence interval,CI）1.01～1.16,P=0.019）]和肠内营养制剂中含钠量（670 mg）(OR 6.00,95%CI 1.61～22.42,P=0.006)是导致IAH发生的独立危险因素。前3 d总排尿量ROC曲线下面积达到0.800(95%CI 0.678～0.922,P=0.001)。患者28 d存活率与IAH的持续时间呈显著相关性（P=0.020）。结论 脓毒症休克时，IAH是常见和严重的并发症，是患者预后不佳的主要原因。血钠的状态可被认为是适用于脓毒症休克患者的一种理想的筛查工具。更多还原

【Abstract】 Objective To evaluate the effects of intensive care unit(ICU)-acquired hypernatremia(IAH) on the outcome of septic shock patients. Methods This retrospective study analyzed 116 septic shock patients admitted to the ICU of the First Affiliated Hospital of Soochow University from August 2018 to December 2022. Patients were divided into two groups: IAH group and normonatremia group. χ2 test, t test and the Mann-Whitney U test of the non-parametric test were used to compare the differences in clinical data between the two groups. Independent risk factors for IAH were identified by unconditioned Logistic regression analysis, and receiver operating characteristic(ROC) curves were constructed to determine their role in predicting IAH. The Kaplan-Meier curve was used to evaluate the effects of IAH and its duration on 28-day survival. Results Renal insufficiency, K+ concentration, body temperature max, mechanical ventilation, chronic critical illness, rapid recovery, sepsis-associated encephalopathy, persistent inflammation,immunosuppression and catabolism syndrome, and the length of stay in ICU had significant differences(P<0.05).Multivariate logistic regression analysis showed: total urine volume in the previous 3 days [odds ratio(OR) 1.09, 95%confidence interval(CI) 1.01-1.16, P=0.019] and sodium content in enteral nutrition preparations(670 mg)(OR 6.00,95%CI 1.61-22.42, P=0.006) were independent risk factors for IAH. In addition, the area under the ROC curve of total urine output in the first 3 days was 0.800(95%CI 0.678-0.922, P=0.001). Finally, the duration of IAH was significantly correlated with 28-day survival rate(P=0.020). Conclusions IAH is a common and serious complication in septic shock,and is the main cause of poor prognosis. Sodium status may act as an ideal screening tool for patients with septic shock.更多还原