重型颅脑损伤并发中枢性低钠血症68例临床分析

Central Hyponatremia after Severe Cerebral Injury with 68 Cases Report

目的:探讨重型颅脑损伤并发中枢性低钠血症的病因、发病机制、鉴别诊断及防治。方法:总结我院重型颅脑外伤后中枢性低钠血症患者68例,根据其临床特点及检查结果诊断为脑性盐耗综合征(CSWS)39例和抗利尿激素分泌不当综合征(SIADH)29例,对其检查结果进行分析,并分别给予补液补盐或限液补盐等相应治疗。结果:重型颅脑损伤患者出现低钠血症的时间为伤后2～16d,平均(5.24±2.38)d;低钠血症持续时间3～14d,平均(4.74±1.65)d。CSWS组与SIADH组CVP水平有显著差异。结论:对重型颅脑损伤患者应密切监测血钠浓度,准确鉴别中枢性低钠血症的类型是有效治疗的前提条件。

Objective：To study the causes, pathogenesis,differencial diagnosis and treatment of central hyponatremia after severe cerebral injury.Methods：68 cases of central hyponatremia after severe cerebral injury were divided into two groups according to the clinical feature and laboratory findings：39 cases of cerebral salt wasting syndrome（CSWS） and 29 cases of syndrome of inappropriate secretion of antidiuetic hormon（SIADH）.They were treated with salt and volume replacement or fluid restriction separately, and the laboratory findings were analysised. Results：Hyponatremia cases were found 2 to 16 （5.24±2.38） days after severe cerebral injury, and last for 3 to 14 （4.74±1.65） days.The central venous pressure（CVP） level differed significantly between CSWS group and SIADH group.Conclusion：Serum sodium should be monitored intimately.Making a distinction between CSWS and SIADH is the precondition of appropriate therapy,