读医学网

根据一项新的回顾性研究，创伤性髋关节骨折术后常出现低钠血症。桑德韦尔和西伯明翰医院NHS信托市医院的James Edward Rudge 和 DanielKim博士在他们的六月七日在线发表在年龄和老化杂志上报道中说，“这项研究表明，在这组患者中，预料术后平均血清钠浓度会下降。”

研究人员写道，15%-30%的住院病人出现中度低钠血症（130-135 mmol/L），虽然电解质紊乱也可为外科手术的晚期并发症。他们补充说，外科手术后低钠血症是常见的。

为探索髋关节骨折术后低钠血症的发生率及其风险因素，拉奇博士和基姆博士观察了他们单位201年254例创伤后髋关节手术的病人。手术后平均血清钠下降了1.8 mmol。27%患者出现中度低钠血症，而9%出现严重低钠血症（＜130 mmol／L）。

研究人员发现，用选择性5羟色胺再摄取抑制剂、质子泵抑制剂和用多种药物的患者均更容易发生低钠血症。低钠血症与性别、手术程序、骨折类型、种族或美国麻醉医师协会等级之间没有关联，低钠血症患者平均住院时间为30天，而正常血钠患者21天。

研究者指出，在目前的研究中，术后低钠血症发生率高于过去的研究；一项研究发现患者术后前六天低钠血症的风险为6%，而另项研究发现术后前三天风险为3%。他们注意到第二项研究中也发现低钠血症病例最多的也是髋部骨折患者。”作者写道，目前的研究提供的证据表明，这个手术病人亚群术后低钠血症的风险更大”。

他们总结道“手术过程本身可能是一个危险因素，应考虑所有患者都有出现这种情况的风险。”

Hyponatremia Frequent After Surgery for Traumatic Hip Fracture

NEW YORK (Reuters Health) - Hyponatremia is common after surgery for traumatic hip fracture, according to a new retrospective review.

This study provides evidence that an average post-operative drop in serum sodium concentration should be expected in this patient group, Dr. James Edward Rudge and Dr. Daniel Kim of City Hospital, Sandwell and West Birmingham Hospitals NHS Trust write in their report, published online June 7 in Age and Ageing.

From 15% to 30% of hospital inpatients develop moderate hyponatremia (130-135 mmol/l), while the electrolyte disorder can also be a late complication of surgery, the researchers write. Hyponatremia is also common after orthopedic surgery, they add.

To examine the incidence of hyponatremia after hip fracture surgery as well as risk factors for the disorder, Dr. Rudge and Dr. Kim looked at 254 patients who underwent hip surgery after trauma in their unit in 2012. Mean serum sodium dropped by 1.8 mmol after surgery. Twenty-seven percent of patients developed moderate hyponatremia, while 9% developed severe hyponatremia ( 130 mmol/l).

Patients on selective serotonin reuptake inhibitors, those on proton pump inhibitors, and those on an increasing number of medications were all significantly more likely to develop hyponatremia, the researchers found. There was no association between gender, operative procedure, fracture type, ethnicity, or American Society of Anesthesiologists grade. Average hospital stay was 30 days for the hyponatremic patients, versus 21 days for the normonatremic patients.

The rate of postoperative hyponatremia in the current study was higher than seen in past studies, the researchers note; one study found a 6% risk in orthopedic surgery patients for the first six days after surgery, while another found 3% in the first three days after surgery. The second study, they note, also found most cases of hyponatremia occurred in hip fracture patients. The current study provides evidence that this subset of orthopedic patients is at greater risk of post-operative hyponatremia, the authors write.

The operative process itself may be a risk factor and all patients should be considered at risk of developing the condition, they conclude.