Research On The Prognosis And Changes Of Urinary Sodium, Serum AVP And ANP In Patients With Severe Traumatic Brain Injury Complicating Hypernatremia

Study on the Incidence and Prognosis of Hypernatremia in Patients with Severe Traumatic Brain InjuryObjective:To analyse the incidence and prognosis of hypernatremia in patients with severe traumatic brain injury(sTBI), and to raise awareness on the sTBI patients with hypernatremia.Methods:135 sTBI patients were included in this retrospective study. The following information was recorded:clinical data, Glasgow Coma Scale(GCS), serum sodium and prognosis and so on. Analyse the incidence of hypernatremia in the sTBI patients and the relationship with GCS. Furthermore, to investigate the relationship between hypernatremia and mortality in the sTBI patient, and the relationship between severity of hypernatremia and the risk of death for the sTBI patient.Results: ①Among the 135 sTBI patients,50 had hypernatremia, and the incidence of hypernatremia was 37.0%(50/135). The mortality rate of patients with hypernatremia was 64.0%(32/50) which is higher than that of the patients without hypernatremia. ②The mortality rates for the mild, moderate, and severe hypernatremia groups were 33.3%(3/9), 53.3%(8/15) and 80.8%(21/26), respectively. ③The 135 sTBI patients were divided into two groups:59 had high GCS (6≤GCS≤8) and 76 had low GCS (3≤GCS≤5). The low GCS group had a significantly more incidence of hypernatremia than high GCS group(48.7%vs22.0%).Conclusion: ① The incidence of hypernatremia is high in sTBI patients and its prognosis is poor. ②The higher the serum sodium level is, the worse prognosis will occur.③The severity of hypernatremia was closely related to the GCS, the lower the GCS, the higher the incidence of hypernatremia.Study on the Changes of 24 Hours Urinary Sodium in Patients with Severe Traumatic Brain Injury Complicating HypernatremiaObjective:To investigate the changes of 24 hours urinary sodium in sTBI patients with hypernatremia.Methods:20 sTBI patients had hypernatremia and 20 had normal serum sodium were selected.20 healthy volunteers were selected as normal control group meantime, and the data of these three groups’ 24 hours urinary sodium was collected and analyzed.Results:The average level of 24 hours urinary sodium in hypernatremia group, normal serum sodium group, normal control group was 179.10±31.84mmol,211.10±29.01mmol, 203.00±33.11mmol,respectively. The hypernatremia group had a significantly lower levels of 24 hours urinary sodium than the normal serum sodium group(P< 0.05). No significant difference in the levels of 24 hours urinary sodium was observed between normal serum sodium and normal control group(P>0.05).Conclusion:The decrease of sodium excretion may be an important reason of the occurrence of hypernatremia.Research on the Changes of Serum AVP and ANP in sTBI Patients with HypernatremiaObjective:To investigate the changes of serum arginine vasopressin(AVP) and atrial natriuretic peptide (ANP) in sTBI patients with hypernatremia.Methods:20 sTBI patients had hypernatremia and 20 had normal serum sodium were selected.20 healthy volunteers were selected as normal control group meantime, and the data of these three groups-serumAVP and ANP was collected and analyzed.Results: ①The average serum AVP level in hypernatremia group, normal serum sodium group and normal control group was 9.38±4.00pg/ml,21.04±3.51pg/ml,12.94±4.11pg/ml, respectively. The difference among the three groups were significant. ㏕he average serum ANP level in hypernatremia group, normal serum sodium group and normal control group respectively was 67.62±17.18pg/ml,70.45±.66pg/ml,81.54±13.87pg/ml. The sTBI patients had a significantly lower serum ANP level than the normal control group(P< 0.05). No significant difference in serum ANP level was observed between hypernatremia group and normal serum sodium group(P>0.05).Conclusion:①AVP may be one of the major neuroendocrine factors in the occurrence of hypernatremia.②ANP may be a critical indicator of brain injury.③ANP may not be involved in the occurrence of severe brain injury complicated with hypernatremia.