颅脑外伤后脑性盐耗综合征的观察与护理

Observation and Nursing Care for Cerebral Salt Wasting Syndrome After Cerebral Trauma

目的探讨颅脑伤后脑性盐耗综合征（CSWS）的观察和护理。方法对13例颅脑外伤后发生CSWS患者的临床数据进行回顾性的分析,观察患者意识变化,监测尿量、尿比重、血清钠、血浆渗透压、血抗利尿激素（ADH）浓度及中心静脉压（CVP）,并探讨相应的护理对策。结果13例患者中,伤后第4～7天血钠平均107mmol/L,尿钠平均为62mmol/L,血渗透压平均205mOsmol/kg,抗利尿激素浓度不高,尿渗透压平均409mOsmol/kg,尿比重平均1·025,其中5例治疗上予以限水,出现低血钠伴有中心静脉压下降,意识障碍加深;补足水、盐后,伤后第14～21天,血钠平均回升至137mmol/L,基本恢复正常。2w恢复8例,4w内恢复3例,1例患者伤后7d死亡。结论在脑性盐耗综合征病人的护理环节上要重视预见性护理,严密观察病人意识状态及生命体征、监测血生化指标、准确记录出入量,掌握好补钠、补液的均衡速度,维持血容量及钠的平衡,掌握脑性盐耗综合征、抗利尿激素分泌不当综合征、中枢尿崩症三类不同的病症的鉴别护理。

Objective To investigate the observation and nursing care of cerebral slat . wasting syndrome （CSWS） after cerebral trauma. Methods To retrospectively analyze the clinic indictors for 13 cases with CSWS after serious cerebral trauma. The change of consciousness , urine amount; urine specific gravity ; serum sodium; plasma osmotic pressure; concentration of antidiuretie hormone and central venous pressure were observed regularly, so to explain the relative measures of nursing care. Results 4 - 7 days after cerebral trauma, blood sodium urine, urine natrlum, blood osmotic pressure, urine osnlotic pressure and urine specific gravity averaged 107 mmol/L, 62 mmol/L 205 m0sm/L, 409 mOsm/L and 1. 025 respectively. Among them, 5 cases were treated with fruited water, who would be given enough water and salt if central venous pressure would decline when hyponatrimia appeared 14 - 21 days after trauma, the blood natrium would rise to 137 mmol/L, which general recovered to normal. 8 cases recovered within 2 weeks, 3 within 4 weeks, 1 died on the 7 days after trauma. Conclusion It is vital for CSWS to attach important to predictive nursing care, observe patients＇conscious state and VS, monitor biochemical indicators, control the speed of fluid and sodium replacement , sustain the balance of blood volume and sodium. It is necessary to handle different nursing measures of CSWS, Central Diabetes Insipidus and Syndrome of Inappropriate Secretion of Antidiuretie Hormone （SLADH） .