小儿结脑水电解质和酸碱平衡紊乱临床类型的鉴别和处理

Differentiation and Treatment of Clinical Types of Water,Electrolyte and Acid-Base Imbalance in TB Meningitis in Children

本文报告中晚期儿童结脑伴水电解质紊乱48例,病儿多属混合性酸碱紊乱。多为低钠血症和代谢性碱中毒,严重低钠血症可致病情加重、诱发惊厥、昏迷甚至死亡。代谢性碱中毒多系持续性颅压高,顽固性呕吐和不能进食引起,并难于纠正。待呕吐停止,进食后代碱即见好转。长期应用激素和利尿脱水剂不是引起代碱的主要原因。

Water-electrolyte and acid-base disturbances were usually seen in the second andlate stages of tuberculous meningitis in children. They were mostly of a mixed type.Low serum sodium and metabolic alkalosis occurred more commonly. Severe hypona-tremia could worsen the patient's situation and evoke convulsions or coma, evendeath.Metabolic alkalosis was due to persistent high CSF pressure, persistent vomitingand difficulty in eating. It was difficult to correet. By stoping vomiting and imp-roving oral intake, metabolic alkalosis might be improved. A longer period of treat-ment with steroid and diuretics were not the major causes of metabolic alkalosis.