腹膜透析治疗小儿重症颅脑损伤并严重高钠血症的临床研究

Clinical study of peritoneal dialysis treatment on severe traumatic brain injury with severe hypernatremia in children

目的：观察腹膜透析对小儿重症颅脑损伤合并严重高钠血症的治疗效果。方法对47例重症颅脑损伤合并严重高钠血症患儿，观察腹膜透析前后血钠浓度变化及其规律，并经有创颅内压监测颅内压变化，评估腹膜透析对颅内压的影响，测定血浆晶体渗透压、血肌酐和血气分析、血压、心率等的变化，评估腹膜透析治疗的效果与安全性。结果与治疗前相比，血钠每天均下降，以第1天下降幅度大，速度快（187．49±2．91 vs 202．48±9．31，P＜0.05），其后降钠速度减慢。持续颅内压监测颅内压逐渐下降，第1天下降明显（164．58±5．98 vs 177．83±7．47，P＜0.05）。腹膜透析期间，血浆晶体渗透压下降，酸中毒纠正，生命体征稳定。结论腹膜透析可有效治疗重型颅脑损伤后高钠血症，与其弥散、降低颅内压等因素有关，临床安全有效。

Objetive To observe the clinical effect of peritoneal dialysis on severe craniocerebral injury combined with severe hypernatremia in children. Methods 47 cases of severe craniocerebral injury combined with severe hypernatremia were involved in the study.The effect and safety of peritoneal dialysis were valued through observing the change and its variety law of the patients’serum sodium concentration before and after the peritoneal dialysis treatmen,monitoring their intracranial pressure changes,evaluating the effect of peritoneal dialysis on intracranial pressure,and measuring the changes in plasma crystal osmotic pressure,blood creatinine and blood gas analysis,blood pressure,heart rate,etc. Results Compared to what before treatment, the blood sodium decreased day by day,with the decrease very sharp on the first day （187.49 ±2.91vs 202.48 ±9.31,P〈0.05）,then slowed down in the following days;and the intracranial pressure decreased gradually,with the decrease obvious on the first day （164.58 ±5.98 vs 177.83 ±7.47,P〈0.05）.During the process of peritoneal dialysis,plasma crystal osmotic pressure declined,acidosis was corrected,vital signs kept stable. Conclusion Peritoneal dialysis is an effective and safe way in treating severe craniocerebral injury with hypernatremia.This contributes to its diffusing and reducing the intracranial pressure,etc.