颅脑手术后并发脑性盐耗损综合征的诊疗分析

Clinical analysis of Cerebral salt wasting syndrome after craniotomic operation

目的探讨脑性盐耗损综合征 (CSW)的临床诊治。方法对我科自 1998年 6月～ 2 0 0 3年 6月诊治的 37例颅脑手术后并发CSW病例的临床资料进行回顾性分析。结果本组患者颅脑手术后均常规应用甘露醇脱水以降颅压 ,诊断为CSW后停用或减量。所有患者以 3%NaCl溶液静脉滴注补钠 ,补液总量为 5 0mL·kg-1·d-1。选择性运用红细胞悬液和垂体后叶素制剂。经治疗后临床情况均明显改善 ,未发生不良反应 ;治疗时间平均 (6 .0 5± 2 .2 6 )d ;治疗时间与治疗前血清钠、2 4h尿钠和中心静脉压无明显相关性。结论颅内不同部位、性质的疾病在开颅手术治疗后均可能发生CSW ,中心静脉压的监测对其诊治具有指导意义 ;采用高张盐水 (3%NaCl)溶液补钠并补充血容量能有效治疗CSW。

Objective To explore the diagnosis and treatment of cerebral salt wasting syndrome(CSW). Methods We analyzed 37 patients with postoperative CSW who were diagnosed and treated in our department between June 1998 and June 2003. Results All the patients responded to the treatment and recovered well. The duration for correction in patients with CSW was ( 6.05±2.26)d,and it had no linear correlation with serum sodium and 24 h urine sodium before treatmeant. Conclusion CSW may occur after operation for different kinds of intracranial di- seases in different positions. Monitoring the central venous pressure has guiding significence for the diagnosis and treatment of CSW. Intravenous hydration with hypertonic saline(3%NaCl) and volume supplementation is an effective method for treating CSW.