颅脑损伤继发脑性耗盐综合征的临床研究

injury Clinical study of cerebral salt wasting syndrome after craniocerebral

目的探讨颅脑损伤继发脑性耗盐综合征（CSWS）患者的相关激素水平和氢化可的松对本病的疗效。方法检测54例颅脑损伤继发CSWS患者促肾上腺皮质激素（ACTH）、皮质醇（CTS）和醛固酮（ALDO）含量。将患者分为对照组和治疗组各27例,分别采用单纯补钠和氢化可的松加补钠治疗,并比较两组治疗前后的血清钠和尿钠的变化。结果（1）颅脑损伤继发CSWS患者中,ACTH和CTS分别为（52．8±7．1）ng/L和（0．69±0．17）μmol/L,均明显高于正常值（P＜0．05）;而ALDO平均值为（0．15±0．03）nmol/L,明显低于正常值（P＜0．05）。（2）治疗后第5天和第10天,治疗组和对照组的平均血清钠分别为（127．5±4．2）mmol/L、（131．1±4．3）mmol/L和（124．4±4．5）mmol/L、（128．3±4．7）mmol/L,治疗组平均血清钠均明显高于对照组（P＜0．05）;治疗组和对照组的平均尿钠分别为（99．0±20．0）mmol/24 h、（89．8±21．6）mmol/ 24 h和（122．3±51．7）mmol/24 h、（105．2±24．7）mmol/24 h,治疗组均明显低于对照组（P＜0．05）。结论颅脑损伤继发CSWS与血浆ALDO水平下降有关,氢化可的松能提高颅脑损伤继发CSWS患者的血钠水平。

Objective To study the changing of relative hormone in patients with cerebral salt wasting syndrome（CSWS） after head injury and the clinical effect of being treated with hydrocortisone in these patients. Methods 54 patients with CSWS after head injury were enrolled in the study. The plasma contents of ACTH,cortisol （CTS） and aldosterone（ALDO） of these patients were determined. All patients were divided into control group（ n=27） and treatment group（ n = 27）, the first one was treated with saline, the last one was treated with saline and hydrocortisone, then to analyze the changing of serum Na^＋ and 24h excretion Na^＋ before and after therapy in the two groups. Results （1） In the patients with CSWS, the plasma content of ACTH, CTS and ALDO were （52.8 ± 7.1） ng/L, （0.69 ±0.17） 〉mol/L and （0.15 ±0.03）/lmol/L respecrly, ACTH and CTS were significantly higher than those of the normal values while ALDO was lower（P 〈 0.05）. （2） In the fifth day and the tenth day after treatment,serum Na^＋ of the treatment group were （ 127.5 ± 4.2 ） mmol/L and （ 131.1± 4.3） mmol/L respectly, both significantly higher than those of the control group [ （ 124.4±4.5 ） mmol/L and （ 128.3 ± 4.7 ） mmol/L ] （ P 〈 0.05 ）. While 24h excrenon Na^＋ of the treatment group were （99.0 ± 20.0） mmol/24h and （ 89.8 ±21.6 ） mmol/ 24h respeetly,both significantly lower than those of the control group[ （122.3 ±51.7）mmol/24h and （105.2 ± 24.7 ）mmol/24h] （ P 〈 0.05）. Conclusion The CSWS after head injury is relatived to the decreasing level of serum ALDO. Hydrocortisone can raise the plasma Na^＋ contents in patients with CSWS after head injury.