颅脑创伤后尿崩症合并脑性盐耗综合征

Combined central diabetes insipidus and cerebral salt wasting syndrome after traumatic brain injury

目的探讨如何正确认识、早期及时诊断和准确治疗尿崩症合并脑性盐耗综合征，以提高救治成功率。方法回顾性分析6例尿崩症合并脑性盐耗综合征的临床特点：尿量特别异常增多、高脑利钠肽水平和显著尿钠排泄增加是其最显著特征；尿比重、血钠水平和血浆渗透压可以正常；尿量增多单纯加压素疗效不佳，而加用醋酸可的松治疗有效。结果6例患者及时正确诊断为尿崩症合并脑性盐耗综合征，但其中1例患者因为血钠上升过快出现脑桥脱髓鞘病变，最终植物状态；1例患者因脑疝、多脏衰而死亡；其余4例患者治愈出院。结论根据尿崩症合并脑性盐耗综合征的临床特点本文提出其参考诊断标准，及时诊断和正确治疗是成功救治的关键。

Objective To discuss the diagnosis coexistence of central diabetes insipidus and cerebral salt wasting syndrome promptly and treat properly. Method Six patients who suffered central diabetes insipidus combined cerebral salt wasting syndrome were analyzed retrospectively. Its characteristics was massive polyuria which can not be controlled by vasopressin alone, but can be controlled by both vasopresin and cortisone acetate. Sodium chloride saline were mainly used to make up for the loss of water and salt. Other characteristics were including low CVP, high Pro - BNP, high 24 h urine sodium evacuation with normal serum sodium level, higher osmolarity in urine than in serum which was at normal level, and usually normal urine specific gravity. Results One died and one became vegetative state, other four patients discharged with Glasgow Coma Scale 15. Conclusions Monitoring of water and sodium metabolism systemically were critical to diagnose the concurrent DI and CSW. Slow sodium chloride saline supplement, cortisone acetate and desmopressin were the keys to deal with concurrent DI and CSW. With exact diagnosis and treatment promptly, favourable outcome can be achieved.