重度颅脑损伤中枢性低钠血症38例诊治分析

Analysis of diagnosis and treatment of serious craniocerebral injury with central hyponatremia

目的探讨重型颅脑损伤病人并发中枢性低钠血症的病因、诊断及治疗。方法回顾性分析重型颅脑损伤后发生中枢性低钠血症病人38例,根据病人的临床表现及实验室指标明确诊断,制定有效的治疗方法。结果10例诊断为抗利尿激素分泌失调综合征(SIADH)的患者经限水治疗,待尿钠降至正常以下再补充钠盐,其中1例在治疗中昏迷程度加深,经补充3%高渗盐水并予呋塞米后缓解,7例病情好转血钠恢复正常,2例死亡。28例诊断为脑性盐耗综合征(CSWS)的患者在积极扩容补液、酌情适量补充3%高渗盐水治疗5～7天后,病情缓解。结论SIADH和CSWS是重型颅脑损伤病人并发中枢性低钠血症的常见病因,两者发病机制及治疗措施不同,对其进行正确诊治能降低颅脑损伤病人的致残率和病死率。

Objective To discuss the causes, diagnosis and treatment of hyponatremia in serious cerebral injured patients. Methods Thirty eight patients with subsequent hyponatremia of central origin after craniocerebral injury were retrospectively analyzed on clinical manifestation, laboratory examination and therapeutic course. Results 10 cases of SIADH among the 38 patients were retricted water intake, then were replenished by 3% hyper-saline after the natrium of blood in well-balanced. 7 patients ~ condition inmproved and the blood natrium healed, 2 cases died. During the treatment the carotic degree of 1 case deepened, and healed by infused 3% hyper-saline. 28 cases of CSWS among the 38 patients . were cured in 5 - 7 days by positive rehydration treatment and proper replenishment of 3% hyper-saline. Conclusion SIADH and CSWS are the common causes of hyponatremia in serious cerebral injured patients. Since the pathogenesis and treatment of SIADH and CSWS are different, the correct diagnosis of them are very important to decline the disabled and mortality rate.