重型颅脑损伤后高钠血症的临床分析及处理

Clinical analysis and treatment of patients with hypernatremia after severe head injury

目的探讨重型颅脑损伤后高钠血症的病因、发生机制,对患者预后的影响及防治对策。方法回顾性分析76例重型颅脑损伤后发生高钠血症患者的临床资料和临床转归,并对所得结果进行统计学处理。结果出现高钠血症38例。高钠血症与GCS评分关系密切,并发高钠血症的重型颅脑损伤患者病死率明显增高。结论下丘脑损害及医源性脱水过多致水电解质失衡是高钠血症的主要原因,密切监测血钠浓度、及时调整水电解质平衡、积极治疗原发病是防治重型颅脑损伤后高钠血症的关键。

Objective To investigate the causes,mechanism,prognosis,and managements of hypernatremia after severe head injury.Methods Clinical data and prognosis were analyzed on 76 patients with hypernatremia after severe head injury.Some statistical processes were performed.Results Hypernatremia occurred in 38 cases.All were closely related to the GCS score.The mortality rate of the patients with hypernatremia after severe head injury increased singificantly.Conclusion The occurrence of hypernatremia is mainly related to hypothalamus injury and water-electrolyte imbalance induced by iatrogenic dehydration.Monitoring the blood sodium concentration closely,adjusting the water electrolyte balance timely and treating the primary disease actively are key points to preventing and treating the hypernatremia after severe head injury.