耳鼻咽喉科急性水中毒的临床分析

Clinical analysis of acute water intoxication in ENT

目的:探讨耳鼻喉科并发急性水中毒的临床特点。方法:对耳鼻咽喉科疾病治疗时出现严重腹痛腹胀、恶心、呕吐、顽固性呃逆、头痛、头昏、嗜睡、昏睡、抽搐、昏迷等症状的患者进行血电解质、血渗透压、尿钠检查。24例血钠<135 mmol/L,血渗透压<270 mOsm/L,尿钠>30 mmol/L,诊断为急性水中毒。其中扁桃体切除术后6例;鼻內镜手术或鼻中隔黏膜下切除手术后5例;应用去氨加压素止血治疗10例;脑膜瘤手术后1例;鼻咽癌1例;咽部恶性淋巴瘤1例。应用20%甘露醇250 mL加呋塞米20 mg静脉滴注12例,另12例直接应用10%氯化钠治疗。结果:在耳鼻咽喉科发生急性水中毒易被误诊,24例中误诊为胃肠炎6例,肠痉挛2例,癫痫2例,偏头痛2例,癔症1例。补钠治疗明显优于脱水利尿治疗,7例脱水利尿无效的补钠治疗仍有效。结论:血钠浓度<135 mmol/L时出现消化系统症状为主,<130 mmol/L可出现消化系统症状加神经系统症状,而消化系统症状在先,<120 mmol/L几乎都是神经系统症状。治疗上补钠为主,脱水和利尿治疗不是首选的治疗方法。

Objective： To explore the clinical characteristics of acute water intoxication in ENT. Methods： Patients who had serious symptoms such as abdominal pain, abdominal distension, nausea, vomiting, intractable hiccups, headache, dizziness, somnolence, stupor, convulsions, coma and so on, were given blood electrolyte examination. 24 patients ,whose blood sodium were below 135 mmol/L, blood osmotic pressure below 270 mOsm/L and urine sodium over 30 mmol/L were diagnosed acute water intoxication. According to the pathogenesis,6 cases occurred after tonsillectomy, 5 after endoscopic sinus surgery or submucous resection of nasal septum, 10 after the hemostatic treatmen of desmopressin, 1 after meningioma surgery, 1 in nasopharyngeal carcinoma, 1 in pharyngeal malignant lymphoma. 12 cases were treated with 20% mannitol 250 mL and furosemide 20 mg by vein. Another 12 cases were treated with 10% sodium chloride immediately. Results： Acute water intoxication in ENT can be misdiagnosed easily. 24 cases were misdiagnosed as gastroenteritis in 6 cases, intestinal spasm in 2 cases, epilepsy in 2 cases, migraine in 2 cases and hysteria in lcase. The treatment of supplying sodium is obviously better than the dehydration and diuretic therapy, the symptoms of the invalid cases can be relieved as well after treating with 10% sodium chloride. Conclusion： When serum sodium concentration is below 135 mmol/L, some symptoms mainly occur in the digestive system symptoms. When below 130 mmol/L,both the digestive and nervous system have symptoms, but digestive system symptoms are prior. When below 120 mmol/L,almost nervous system symptoms appear. The preferred treatment for acute water intoxication is not dehydration and diuretic therapy but supply the sodium.