脑性盐耗综合征27例临床分析

Clinical analysis of 27 cases of cerebral salt wasting syndrome

目的:探讨神经外科患者并发脑性盐耗综合征(CSWS)病因、发病机制、诊断及治疗方法。方法:回顾性分析27例低钠血症患者的临床表现和实验室检查指标,明确诊断,确定有效的治疗方法。结果:22例患者低钠血症恢复,5例死于其他并发症。结论:虽然CSWS发生机制尚不太明确,可能与神经对肾脏的传出障碍亦或利尿钠因子分泌紊乱有关。不同的是,SIADH需限制补液,而CSWS需补液、补钠。因此,两者的鉴别诊断至关重要。CVP测定和血浆ADH水平对鉴别诊断有重要意义。

Objective： To explore the pathogenesis mechanism,diagnosis and treatment of cerebral salt wasting syndrome （CSWS） in the neurosurgical patients. Methods： Based on clinical manifestations and laboratory examination of 27 cases of hyponatremia were retrospectively analyzed and the effective therapy was provided. Results： In this series. 22 cases were cured and 5 cases died asociated with other complications. Conclusion： Although the exact mechanism of the development of CSWS has not been elueieated, the disruption of neural input into the kidney and/or central elaboration of circulation natriuretie factors are considered to be the possible mecharismes. Unlike SIADH requiring fluid restriction, CSWS requies fluid and sodium replacement;thus, differential diagnosis between these two conditions is critical, and CVP,the serum levels are very important for the diffierential diagnosis.