重型颅脑损伤并发低钠血症的临床诊治分析

The analysis of diagnosis and therapy of severe craniocerebral injured patient with Hyponatremia

目的探讨重型颅脑外伤患者并发低钠血症的临床特点、发病机制及治疗方法。方法回顾分析近5年来收治的重型颅脑损伤患者318例,其中并发低钠血症患者51例,总结其临床特点、病情发展转归及有效治疗经验,分析低钠血症发病机制及相关因素和治疗方法。结果本组51例患者经补钠治疗血钠均恢复正常,最终死亡21例。结论重型颅脑损伤并发低钠血症的主要发生机制是抗利尿激素分泌异常综合征(SIADH)及脑耗盐综合征(CSWS)。低钠血症的治疗在于早期发现,早期明确病因,早期治疗。治疗措施中胃肠道补钠是一种简单、安全、有效的方法。

Objective To investigate the clinical features,pathogenesis and treatment of severe craniocerebral injury patient with hyponatremia.Methods Clinical features,diagnosis,prognosis, outcome and effective treatment experience of 51 patients with hyponatremia of 318 cases with severe craniocerebral injury which lasted for 5 years were reviewed.The pathogenesis of hyponatremia and the relevant factors and treatment were analyzed.Results The serum sodium of 51 patients was back to normal through supplement of sodium.Twenty-one patients eventually died. Conclusion The main mechanism of severe craniocerebral injury with hyponatremia is the syndrome of inappropriate antidiuretic hormone secretion and cerebral salt wasting syndrome.The treatment of hyponatremia lies in early detection,early diagnosis,and early treatment.Filling natrium through gastrointestinal tract is a simple,safe and effective method.