肝硬化腹水低钠血症的临床探讨

CHINICAL ANALYSIS OF HYPONATREMIA HEPATOCIRRHOSIS ASCITES

对８３例肝硬化腹水合并低钠血症患者进行分析，血钠１３１～１３５ｍｍｏｌ／Ｌ２２例、１２６～１３０ｍｍｏｌ／Ｌ４８例、≤１２５ｍｍｏｌ／Ｌ １３例，死亡２９例，血钠降低与Ｃｈｉｌｄ分级、肾功能以及预后相关（Ｐ＜０．０５，＜０．００５）。６例在原有低钠状态下，利尿与放腹水后发生急性低钠综合征，２例死亡，４例经用３％或１０％氯化钠后恢复。本组临床分析表明，在原有低血钠状态下，特别是对血钠≤１２５ｍｍｏｌ／Ｌ及全身和肝肾功能差者，在同时放腹水与用强利尿剂时应慎重，并应预防急性低钠血症的发生。自身腹水回输为此类患者的治疗开辟了一条新的途径。

Eighty-three cases of hyponatremia commplicating liver cirrhosis were analysed. Amang these cases, 22 patients blood natremid was 131～135mmol/L, 48cases' was 126～130mmol/L and 13 cases's was ≤125mmol/L, In 83patients 29 cases died, the correlation between hyponatremia and child's classification ,renal function and prognosis were found. 6 cases developed acute hyponatremia syndrome after abdominal paracentensis and high-dose of diuretics, of these 6 cases,2died and 4 recoverd after immediate infusion of 3%and 10 % sodium chloride. Based on these clinical studies, it was shown that paracentesis and diuretics are the main causes of acute hyponatremic Syndrorn, so these measure should be taken caretully in patients with hyponatremic state, especially in patients with poor, hepatic and renal conditions. The autogenous reinfusion of ascitic fluid is a safe and effective new mdthod for the cirrhotic patients with ascites.