重型颅脑损伤患者低钠血症临床分析

Clinical analysis of hypernatremia in patients with severe craniocerebral injury

目的探讨重型颅脑损伤患者出现低钠血症的机制、诊断标准和对症处理。方法对NICU收治的158例重型颅脑损伤(入院时GCS≤8分)患者的血钠监测结果进行回顾分析。结果 158例重型颅脑损伤中出现低钠血症(<135 mmol/L)的有96例,其中抗利尿激素分泌不当综合征16例,脑性盐耗综合征10例,外伤性尿崩症2例。结论对于重型颅脑损伤患者伤后并发低钠血症需根据临床表现、监测结果、化验检查明确病因,并根据诊断进行相应的对症处理,可以降低重型颅脑损伤患者的死亡率和改善预后。

Objective To study the pathogenesis, diagnostic criteria and symptomatic treatment of hyponatremia in the patients with severe craniocerebral injury. Methods Serum sodium levels of 158 patients （ from June 2008 to June 2012） were analyzed retrospectively. These patients had severe cranioeerebral injury and were treated in the neurosurgical intensive care unit （NICU） in our department. Results Ninty-six cases had hyponatremia（ 〈135 mmol/L） in total 158 cases. The syndrome of inappropriate antidiuretic hormone secretion（SIADH） was found in 16 cases, cerebral salt wasting syndrome（CSWS） in 10 cases, and traumatic diabetes insipidus（DI） in 2 cases. Conclusion Severe craniocerebral injury patients with hyponatremia should be analyzed based on clinical manifestations, monitoring results, and laboratory tests. Reasonable symptomatic treatment can reduce the mortality and improve the prognosis of these patients.