医院获得性低钠血症与小儿神经危重症的关系

Association between nosocomial hyponatremia and critically neurologic children

目的 探讨不同张力液体对神经系统危重症患儿的血清钠及神经症状的影响．方法 根据入院时血清钠检查值将46例危重神经系统患儿分为两组：低钠血症组（22例）和正常血钠组（24例），前者用1／2～1张液，后者用1／5张液体，之后1．4d每天测血清钠1次，并做Glasgow评分1次，比较两组患儿治疗后电解质情况及神经症状的改变情况。结果 低钠血症组应用1／2-1张液体4d后血清钠由（124．2±2.9）mmol／L升到（142．1±8．1）mmol／L，P〈0.01，Glasgow评分由（8．0±0．8）分升高到（9．9±2．4）分，P〈0．05，神经系统症状明显改善；正常血钠组应用1／5张液体4d血清钠由（139．2±4.1）mmol／L下降到（129．6±6.2）mmol／L，P〈0.05，导致医院内获得性低钠症，Glasgow评分由（11．5±2．1）分下降到（10．6±1.6）分，P〈0．05，神经系统症状渐趋恶化。结论 神经系统危重症患儿早期应用1／2～1张液体，可以防止医院内获得性低钠血症，改善神经系统症状。

Objective To evaluate the effects of different intravenous fluid on serum sodium and neurological symptom of critically neurologic children. Methods According to the level of serum sodium, forty - six patients were divided into two groups： low sodium group （twenty- two cases, Na^＋ 〈 135mmol/L） and normal sodium group （twenty - six cases, Na^＋ 135 - 155mmol/L）, low sodium group treated with fluid of 1/2 to isotonic, normal sodium group with hypotonic fluid of 1/5 tonicity, the level of serum sodium and score of Glasgow were assessed after of one to four days admission. Results After four days, the serum sodiun and Glasgow scores of low sodium group were significantly increased, Na^＋ （ 124.2 ± 2.9 ） mmol/L vs （ 142. 1 ± 8. 1 ） mmol/L, P 〈0.01 ,scales ： （8.0 ±0.8） vs（9.9 ± 2.4）, P 〈 0.05 ,neurological symptom improved. The normal sodium group were dramatically decreased： Na^＋（ 139.2 ±4.1 ）mmol/L vs（ 129.6 ±6.2） mmol/L , P 〈 0. 05, scales ： （ 11.5 ± 2. 1 ） vs （ 10.6 ± 1.6 ） , P 〈 0.05, tonicity of fluid was the reason of nosocomial hyponatremia, neurological symptom were bad. Conclusion Tonicity of fluid（ ≥ 1/2） can be used to treat critically neurologic children during the early time, to prevent hyponatremia and improve neurological symptom.