脑外伤并脑性耗盐综合征36例临床分析

The clinical analysis of 36 cases with traumatic brain injury complicated with cerebral salt wasting syndrome

目的：探讨脑外伤并发脑性耗盐综合征（CSWS ）的诊断和治疗方法。方法对我院2008-2013年收治的36例脑外伤并发CSWS患者的临床资料进行回顾性分析，入院时GCS评分：3～5分8例，6～8分16例，9～12分6例，13～15分6例。诊断为 CSWS后首先予以补钠、补液治疗，如果无好转，依次加用垂体后叶素、卡马西平或强地松、氢化可的松保钠治疗。结果经过补钠，23例患者在5～10 d内纠正，5例合用卡马西平、垂体后叶素3～7 d后纠正，7例最后合用糖皮质激素（低钠13～25 d ），其中2例停用糖皮质激素后，低钠复发，再补钠1～2周后，低钠纠正，另外1例低钠纠正过程中，死于颅内感染。结论脑外伤后并脑性耗盐综合征是导致低钠血症发生的主要原因，CSWS的早期诊断和积极的治疗可缩短住院时间，减少患者痛苦和经济负担。

Objective To investigate the diagnosis and treatment of brain injury complicated with cerebral salt wasting syndrome （CSWS）.Methods 36 cases of cerebral trauma complicated with CSWS from 2008 to 2013 year in our hospital were retrospectively analyzed. GCS score at admission ：3-5 ,8 cases ;6-8 ,16 cases ;9-12 ,6 cases ;13-15 ,6 cases.If the diagno-sis was CSWS ,first therapy was sodium ,fluid replacement ,and if no improvement ,in turn was pituitrin ,carbamazepine or prednisone ,hydrocortisone was used to protect the sodium.Results After administration of sodium ,23 patients were cured in 5-10d ,while 5 patients were given carbamazepine ,pituitrin in 3-7 days after correction.Other 7 cases were finally combined with Glucocorticoid （hyponatremia 13 - 25 days ） , including 2 cases of hyponatremia been corrected after another1 - 2 weeks.Another example of hyponatremia in correction process ,were died of intracranial infection. Conclusion Traumatic brain injury complicated with cerebral salt wasting syndrome is the main reason leading to hyponatremia.If CSWS is early diagnosed and given positive treatment ,it can shorten hospitalization days ,reduce the pain and economic burden of patients.