结核性脑膜脑炎合并低钠血症的病因和诊断治疗分析

Analyze pathogenesis,diagnosis and treatment for tuberculous meningitis and encephalitis combined with hyponatremia

目的:探讨研究结核性脑膜脑炎合并低钠血症的病因并对其进行诊断治疗分析。方法:选择患有结核性脑膜脑炎合并低钠血症的患者31例,分为轻中度组(A组)和重度组(B组),A组15例,B组16例。两组均取抗痨方案规范治疗,A组轻中度者,限水<500 ml,依据血钠监测值,取50～250 ml 3%高渗盐水临床静脉滴注,血钠在3～7 d后呈正常恢复;B组重度者,先采取有效措施使循环功能、呼吸改善,取3%高渗盐水250～1 000 ml在心功能条件许可下持续补充,血钠浓度水平升高后,剂量适当减少,调整为1 000～2 500 ml生理盐水应用。结果:B组患者的总有效率明显低于A组患者,差异有统计学意义(P<0.05),B组患者的痊愈率和改善率明显低于A组,而死亡率明显高于A组,差异有统计学意义(P<0.05)。两组患者发生低钠血症的原因差异无统计学意义(P>0.05)。结论:低钠血症是结核性脑膜脑炎患者较为常见的并发症,分析患者的发病因和及时准确的诊断治疗显得尤为重要,其意义深远。

Objective To investigate the etiology of tuberculous meningitis complicated with hyponatremia and analysis of its diagnosis and treatment.Methods 31 cases of patients with tuberculous meningitis complicated with hyponatremia,divided into mild to moderate group（group A） and severe group（B group）,15 cases in A group,B group of 16 cases.The two groups were taking anti-tuberculosis scheme standard treatment,A group with mild to moderate,to limit the water〈 500 ml,based on the monitoring value of blood sodium,50 - 250 ml 3% hypertonic saline clinical intravenous infusion,blood sodium in 3 - 7 d after a normal recovery; group B,severe,to take effective measures to improve the circulation,respiration,3% hypertonic saline in 250 - 1 000 ml in cardiac function conditions permit continuous replenishment,elevated serum sodium concentration,dosage reduction,the adjustment of 1 000 - 2 500 ml saline application.Results The patients in the B group the total efficiency was significantly lower than that in A group,the difference was statistically significant（P〈0.05）,patients in the B group the cure rate and improvement rate was significantly lower than that of A group,but the mortality rate was higher in the A group,the difference was statistically significant（P〈0.05）.No significant differences in cause of hyponatremia in the patients of the two groups（P〉0.05）.Couclusion Hyponatremia is a common complication in patients with tuberculous meningoencephalitis,analysis of patients with disease due to timely and accurate diagnosis and treatment is very important,it is of far-reaching significance.