中枢性低钠血症的临床特点

Clinical characteristics of central hyponatremia

目的探讨中枢性低钠血症的临床特点。方法回顾性分析34例中枢性低钠血症患者的临床资料。结果34例患者均因不同的脑部疾病住院治疗过程中,在原有疾病的基础上出现烦躁、嗜睡、意识障碍加深、呕吐、肢体抽搐及脱水表现;实验室检查:34例患者血钠均<135 mmol/L,尿钠均>260 mmol/d;8例中心静脉压检测,5例低于6 cmH2O。19例诊断为中枢性低钠血症——抗利尿激素不适当分泌综合征(SI-ADH),7例为中枢性低钠血症——脑性盐耗综合征(CSW S),另8例初诊为SIADH,因脱水治疗后症状加重,修正诊断为CSW S。19例SIADH患者给予限水、利尿治疗,15例CSW S患者予以水化、补钠治疗,数日后所有患者血钠、尿钠基本恢复正常,除3例仍昏迷外,31例病情均有好转。结论低血钠、高尿钠及意识状态改变是中枢性低钠血症的临床特征;SIADH以限水治疗为原则,CSW S则以水化和补盐治疗为原则。

Objective To investigate the clincal characteristics of central hyponatremia. Methods The clinical data of 34 patients with central hyponatremia were analysed retrospectively. Results 34 patients with different cerebral diseases appeared dysphoria, sleepiness, aggravating disturbances of consciousness, vomiting, limb seizures and dehydration basis on primary diseases during the hospitalization. The laboratory examinations showed that the level of blood natrium was 〈 135 mmol/L and urinary natrium was 〉 260 mmoL/d in all the cases, and the central venous pressures in 5 cases were lower than 6 cm H2O among 8 cases. The 19 cases were diagnosed as central hyponatremia syndrome of inappropriate ADH secretion （SIADH）; 7 cases were diagnosed as central hyponatremia cerebral salt wasting syndrome （CSWS）. The other 8 cases were diagnosed as SIADH firstly, but final diagnosis were corrected as CSWS according to the symptoms increasing after dehydration therapy. The 19 case of SIADH received the therapy of limiting water and diuresis, and 15 cases of CSWS received the therapy of hydration and supplementing sodium. The several days after the treatment, the levels of the blood natrium and the urinary natrium were backed to the normal values in all the patients and the condition was improved exapet 3 cases remained coma. Conclusions Hyponatremia, hypernatruria and changes of consciousness are the clinical charateritics of central hyponatremia. The treatment principle in SIADH is limiting water, and in CSWS is hydration and supplementing sodium.