The Clinical Analysis Of The Cirrhotic Ascites With Hyponatremia

Background: Hyponatremia frequently develops in the decompensated cirrhotic patients. Limited salt intaking, unreasonable application diuretics and large volume ascites emissions all constitute to common causes of hyponatremia. The disease onset slowly,its symptoms is conceal, the severe ones can have symptoms of mental disorders, lethargy, delirium, convulsions, coma, even shock etc, hyponatremic encephalopathy, may lead to persistent and serious central nervous system damage.In clinically the hyponatremic encephalopathy is difficult to identify with hepatic encephalopathy, etc. Hyponatremia affected the prognosis of patients with liver cirrhosis and reduce the survival rate. Therefore, the diagnose and preventiong and treatment of hyponatremiain in patients with liver cirrhosis of the decompensation period is bing paid more and more attention by the clinical workers.Aim: To analyse the prevalence, clinical associations with liver cirrhosis complications (hepatic encephalopathy, hepatorenal syndrome, upper gastrointestinal bleeding, spontaneous peritonitis, liver cancer), and the relationship with liver child - pugh ratings, MELD score, mortality(within 30ds), evaluate the clinical significance of hyponatremia of cirrhotic ascites sevre and prognostic impact of hyponatremia in cirrhotic inpatients, and to provide the reference of the reasonable treatment of cirrhosis ascites.Methods: To analyse retrospectively.Obtain the information of 756 patients with cirrhosis ascites from computer in First Clinical Hospital of Jilin University from January 2010 to December 2010 , in which 235 patients were combined with the hyponatremia. To investigate the first bilirubin, serum creatinine, serum sodium, prothrombin time ,international normalized ratio within 72 hours, and calculate the Child-Pugh classification of liver function,MELD score on admission, the happening of complications and death during hospitalization. To analyze the clinical death rate of cirrhosis patients. According to the blood sodium reduce degree, devide all the patients into normal group, mild hyponatremia, moderate hyponatremia, and severe hyponatremia of four groups for statistical analysis.Results: (1) 235cases of hyponatremia were found in 756 patients , the incidence of which is 31.08%, including 152 mild hyponatremia patients inall , accounting for about 64.68percent of the patients with hyponatremia, 53 moderate hyponatremia patients, accounting for 22.55% of total hyponatremia patients; 30 severe hyponatremia cases ,about 12.77% of the patients.(2) There were significant difference of Hyponatremia in cirrhosis complications such as hepatic encephalopathy, hepatorenal syndrome, spontaneity peritonitis, ascites degree (P<0.05). There were no difference of upper gastrointestinal bleeding,primary hepatocelluary carcinoma, and along with the blood sodium gradually decrease, the complication rate is increasing gradually (except primary liver cancer, upper gastrointestinal bleeding ).(3) There were significant difference in Child-Pugh score, MELD score, percentage of events of death, comparing the patients with hyponatremia with that with normal serum sodium (P<0.05, respectively). And with reduced Child-Pugh serum sodium, classification, MELD score is increasing gradually. Namely the lower of sodium blood serum, the poorer liver function is.(4) Serum sodium levels in patients with different mortality(within 30ds)was significant difference (P<0.05).Conclusion: (1) Hyponatremia is easily happened in the cirrhotic patients with ascites. And the percentage of this study achieves 31.8%. (2) There were significant relationship between incidence of hepatic encephalopathy and hepatorenal syndrome, spontaneous perltonitis, degree of ascites. There were no difference incidence of primary hepatocellular carcinoma, upper gastrointestinal hemorrhage.And namely, the more serious the hyponatremia the higher the incidence of hepatic encephalopathy, hepatorenal syndrome, spontaneous perltonitis, complication rate is (except primary liver cancer, upper gastrointestinal bleeding). (3) There were significant relationship between Child-Pugh score, MELD score with hyponatremia, and the lower serum sodium concentration, the poorer liver function is. (4) Serum sodium levels in patients with different mortality(within 30ds)was significant difference (P<0.05).