重型颅脑损伤合并脑性耗盐综合征患者39例血浆脑型利钠肽浓度的变化

Clinical analysis of blood plasma natriuretic peptide change 39 severe brain injury patients with cerebral salt wasting syndrome

目的:探讨重型颅脑损伤合并脑性耗盐综合征患者血浆利钠肽浓度变化,分析二者之间关系。方法:选取重型颅脑损伤合并脑性耗盐综合征39例、单纯重型颅脑损伤患者34例、健康体检正常者40例分为脑性耗盐综合征组、非脑性耗盐综合征组、对照组,入院当日、第5天、第10天、第15天抽血经化学发光方法测定血浆利钠肽、血钠浓度,并行经颅多普勒超声检查,测定大脑中动脉(VmMCA)、大脑前动脉血流速度(VmACA)。结果:重型颅脑损伤合并脑性耗盐综合征患者5d血浆利钠肽水平升高,3组比较1129.1±3.5vs245.2±2.6vs157.2±2.4(P<0.05),经颅多普勒测定脑血流速度明显加快(VmMCA139.2±2.1vs78.3±1.8vs53.4±2.9,P<0.05;VmACA142.1±1.5vs74.8±2.7vs59.2±1.8,P<0.05),持续约10d左右时间,2周后恢复正常水平,与血钠水平波动一致。结论:脑性耗盐综合征组,血浆利钠肽浓度明显升高,提示血浆利钠肽水平与脑性耗盐综合征发生有关。

Objective：To investigat the variation of the natriuretic peptide concetration？ in the plasma of severe brain injury patients with cerebral salt wasting syndrome , and analyzed the relationship between them.Method： Selected 39 patients with severe brain injury with cerebral salt wasting syndrome, 34 patients with severe brain injury , and 40 patients with normal healthy people ,divided them into groups as cerebral salt wasting syndrome group , non-cerebral salt wasting syndrome group and control group, determined the plasma natriuretic peptide, serum sodium concentration by chemiluminescence method on the admission day ,the 5th day ,the 10th day ,the 15th day , and determined the flow velocity of middle cerebral artery （VmMCA） , anterior cerebral artery （VmACA） by transcranial doppler（TCD） ultrasonography.Results ： The plasma natriuretic peptide levels of severe brain injury patients with cerebral salt wasting syndrome escalated after 5 days （1129.1±3.5 VS 245.2±2.6VS 157.2±2.4,P0.05 ）, cerebral blood flow velocity accelerated obviously according to the transcranial doppler ultrasonography （VmMCA 139.2±2.1 VS 78.3±1.8 VS 53.4±2.9, P0.05;VmACA 142.1±1.5 VS 74.8±2.7 VS 59.2±1.8,P0.05）,lasting about 10 days , then returned to normal levels after 2 weeks, consistent with the fluctuations in serum sodium levels.Conclusions： The significant exaltations of plasma BNP concentration in cerebral salt wasting syndrome group, prompted that plasma BNP levels relate with the occurrence of cerebral salt wasting syndrome .