颅脑损伤后抗利尿激素分泌异常综合征诊治体会

Syndrome of inappropriate antidiuretic hormone after serious cerebral injury

目的:探讨颅脑损伤后抗利尿激素分泌异常综合征(SIADH)的诊断与治疗。方法:回顾性分析近7年收治的11例颅脑损伤并发抗利尿激素分泌异常综合征的临床特点。首先按真性失盐常规补钠治疗,2～3d后血钠不回升或继续降低,补钠量与失钠量相当,考虑为SIADH,改为限水、限钠治疗。结果:11例颅脑损伤合并抗利尿激素分泌异常综合征均具有以下临床特点:低钠血症、低血浆渗透压、尿渗透压与血浆渗透压之比>1。治愈10例,死亡1例。结论:颅脑损伤并发抗利尿激素分泌异常综合征的发病机制与治疗措施不同于低钠血症,早期诊治能降低颅脑损伤患者的病残率和死亡率。

Objective： To study the diagnosis and treatment of the syndrome of inappropriate antidiuretic hormone secretion（SIADH）. Methods： Retrospective analysis of clinical features of 11 cases of head trauma with syndrome of inappropriate secretion of antidiuretic hormone treated in the past 7 years.The first of all, sodium losing in these patients with hyponatremia was routine supplied according to the amout of ture salt losing.If natremia was not raised or still more descended 2-3 days after treatment,and amount of supplying salt was corresponded to that of natriuresis,SIADH should be considered, using restricting water therapy,substituted for salt supplement. Results： 11 patients of head trauma with syndrome of inappropriate secretion of antidiuretic hormone showed following clinical features：hyponatremia,low plasma osmotic pressure,the ratio of osmotic pressure of urine and plasma osmotic pressure 〉1. 10 cases have been cured and 1 case died. Conclusion： Pathogenesis and management of head trauma complicated with syndrome of inappropriate antidiuretic hormone secretion are different from that of hyponatremia.Early diagnosis and therapy can reduce morbidity and mortality.