神经外科患者并发低钠血症的临床分析及处理

Clinical analysis and management of hyponatremia in neurosurgical patients

目的探讨神经外科患者并发低钠血症的临床特点及诊断与治疗。方法收集76例并发低钠血症神经外科患者的资料，分析其临床表现、实验室检查和治疗措施，根据不同病因分为四种类型，治疗基础性疾病的同时分别予以不同的治疗方法。结果因摄入不足或强力利尿脱水引起的低钠血症40例，尿崩症15例，脑性盐耗综合征12例，抗利尿激素不适当分泌综合征9例。76例低钠血症均得到纠正。结论神经外科患者并发低钠血症的常见原因是强力脱水利尿治疗的同时摄入不足、尿崩症、脑性盐耗综合征、抗利尿激素不适当分泌综合征，治疗上只要早期发现，及时针对病因处理，均可以较快的予以纠正。

Objective To discuss the clinical characteristics, differential diagnosis and management principles of various types of hyponatremia in neurosurgical patients. Methods The clinical data of 76 cases of hyponatremia in neurosurgical patients were analyzed retrospectively. According to etiological factors, all patients were treated corresponding to their differential diagnosis. Results In 76 patients, hyponatremia occurred due to inadequate supplement and diuretic in 40 cases, diabetes insipidus in 15, cerebral salt wasting syndrome in 12 and syndrome of inappropriate secretion of antiduretic hormone in 9. All patients had been treated to return to new balance. Conclusions The common causes of hyponatremia in neurosurgical patients are inadequate sodium supplement and diuretic, diabetes insipidus, cerebral salt wasting syndrome and syndrome of inappropriate secretion of antidiuretic hormone. As long as hvPonatremia is detected early and treated timely to the above causes, all patients could have good prognosis.