作者：贾瑶，李思彤，梁新慧，李杨，姜雪

单位：

1.空军军医大学第二附属医院神经外科2.陕西中医药大学

Units：

1.Department of Neurosurgery, the Second Affiliated Hospital of Air Force Medical University, Xi'an 710038, China 2.Shaanxi University of Traditional Chinese Medicine, Xianyang 712046, China

关键词：

颅脑损伤; 创伤性颅脑损伤; 低钠血症; 危险因素; Meta分析;

Keywords：

Craniocerebral trauma; Traumatic brain injury; Hyponatremia; Risk factors; Meta-analysis

CLC：

DOI：

10.12114/j.issn.1008-5971.2023.00.120

Funds：

军队护理创新与培育专项计划创新项目（2021HL041）

摘要：

目的 系统评价创伤性颅脑损伤（TBI）患者发生低钠血症的危险因素。方法 计算机检索PubMed、Web of Science、Cochrane Library、Embase、中国知网、万方数据知识服务平台、维普网、中国生物医学文献数据库公开发表的TBI患者发生低钠血症危险因素的研究，对照组为未发生低钠血症的TBI患者，病例组为发生低钠血症的TBI患者。检索时限为建库至2023年1月。提取纳入文献的资料，病例对照研究和队列研究文献质量采用纽卡斯尔-渥太华量表（NOS）进行评价，横断面研究文献质量采用美国卫生保健质量和研究机构推荐的标准进行评价，采用RevMan5.4软件进行Meta分析。结果 本研究纳入24篇文献，共6 062例患者，其中病例组1 965例、对照组4 097例。Meta分析结果显示，年龄增长[加权均数差（WMD）=4.93,95%CI(1.61,8.24),P=0.004]、年龄≥40岁[OR=2.61,95%CI(1.25,5.45),P=0.001]、年龄≥60岁[OR=1.70,95%CI(1.29,2.24),P<0.001]、格拉斯哥昏迷量表（GCS）评分≤8分[OR=2.79,95%CI(1.87,4.16),P<0.001]、中重度损伤[OR=3.55,95%CI(2.15,5.84),P<0.001]、双侧损伤[OR=1.75,95%CI(1.34,2.29),P<0.001]、开放性损伤[OR=2.14,95%CI(1.31,3.51),P=0.002]、颅底骨折[OR=2.68,95%CI(1.54,4.67),P<0.001]、脑水肿[OR=2.10,95%CI(1.75,2.25),P<0.001]、脑挫裂伤[OR=3.20,95%CI(2.35,4.36),P<0.001]、脑疝[OR=2.37,95%CI(1.68,3.34),P<0.001]、蛛网膜下腔出血[OR=1.45,95%CI(1.07,1.95),P=0.020]、脑室出血[OR=2.53,95%CI(1.53,4.18),P<0.001]、使用脱水药[OR=2.52,95%CI(1.45,4.36),P=0.001]、手术[OR=1.58,95%CI(1.04,2.39),P=0.030]、感染[OR=6.64,95%CI(2.14,20.58),P=0.001]、高热[OR=15.00,95%CI(8.10,27.79),P<0.001]、呕吐[OR=2.73,95%CI (1.92,3.88),P<0.001]是TBI患者发生低钠血症的危险因素。结论现有证据显示，年龄增长、年龄≥40岁、年龄≥60岁、GCS评分≤8分、中重度损伤、双侧损伤、开放性损伤、颅底骨折、脑水肿、脑挫裂伤、脑疝、蛛网膜下腔出血、脑室出血、使用脱水药、手术、感染、高热、呕吐是TBI患者发生低钠血症的危险因素，医护人员在临床工作中应及时识别高风险患者并处理相关危险因素，进而降低TBI患者低钠血症的发生率。

Abstract：

Objective To systematically evaluate the risk factors of hyponatremia in patients with traumatic brain injury (TBI) . Methods Databases including PubMed, Web of Science, Cochrane Library, Embase, CNKI, Wanfang Data, VIP, CBM were retrieved to search for studies on the risk factors of hyponatremia in patients with TBI from inception to January in 2023. The control group was TBI patients without hyponatremia, and the case group was TBI patients with hyponatremia. The data of the included literatures were extracted, the Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of the case control study and cohort study, the standards recommended by United States Agency for Healthcare Quality and Research was used to evaluate the quality of the cross-sectional study. RevMan 5.4 was used for meta-analysis. Results A total of 24 articles were included, and involving 6 062 patients, including 1 965 cases in case group and 4 097 cases in control group. Meta-analysis results showed that increased age [weighted mean difference (WMD) =4.93, 95%CI (1.61, 8.24) , P=0.004] , age ≥ 40 years [OR=2.61, 95%CI (1.25, 5.45) , P=0.001] , age ≥ 60 years [OR=1.70, 95%CI (1.29, 2.24) , P < 0.001] , Glasgow Coma Scale (GCS) score ≤ 8 points [OR=2.79, 95%CI (1.87, 4.16) , P < 0.001] , moderate to severe injury [OR=3.55, 95%CI (2.15, 5.84) , P < 0.001] , bilateral injury [OR=1.75, 95%CI (1.34, 2.29) , P < 0.001] , open injury [OR=2.14, 95%CI (1.31, 3.51) , P=0.002] , skull base fracture [OR=2.68, 95%CI (1.54, 4.67) , P < 0.001] , cerebral edema [OR=2.10, 95%CI (1.75, 2.25) , P < 0.001] , cerebral contusion [OR=3.20, 95%CI (2.35, 4.36) , P < 0.001] , cerebral hernia [OR=2.37, 95%CI (1.68, 3.34) , P < 0.001] , subarachnoid hemorrhage [OR=1.45, 95%CI (1.07, 1.95) , P=0.020] , ventricular hemorrhage [OR=2.53, 95%CI (1.53, 4.18) , P < 0.001] , using dehydrating drugs [OR=2.52, 95%CI (1.45, 4.36) , P=0.001] , surgery [OR=1.58, 95%CI (1.04, 2.39) , P=0.030] , infections [OR=6.64, 95%CI (2.14, 20.58) , P=0.001] , high fever [OR=15.00, 95%CI (8.10, 27.79) , P < 0.001] , vomiting [OR=2.73, 95%CI (1.92, 3.88) , P < 0.001] were risk factors of hyponatremia in patients with TBI. Conclusion The available evidence shows that increased age, age ≥ 40 years, age ≥ 60 years, GCS score ≤ 8 points, moderate to severe injury, bilateral injury, open injury, skull base fracture, cerebral edema, cerebral contusion, cerebral hernia, subarachnoid hemorrhage, ventricular hemorrhag, using dehydrating drugs, surgery, infections, high fever, vomiting are risk factors of hyponatremia in patients with TBI. Medical staff should timely identify high-risk patients and deal with related risk factors in clinical work, in order to reduce the incidence of hyponatremia in patients with TBI.

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