低钠血症与老年急危重病临床

Hyponatremia and Common Clinical Conditions in Elderly Critical Illness

低钠血症是老年危重患者常见的电解质紊乱,也是各种老年常见急危重病的并发症之一。老年患者的低钠血症在心力衰竭、重症肺炎、慢性阻塞性肺疾病、急慢性脑血管病及颅脑损伤等内科、神经科疾病中发病率较高,且与预后不良有关。其病理生理机制常为多种原因导致,而神经外科的低钠血症最常见病理生理机制为脑性盐耗综合征和抗利尿激素异常分泌综合征。利尿剂是引起低钠血症的最常见药物,老年患者的低钠血症表现隐匿,常被原发危重病症状掩盖,在临床工作中需加强监测。

Hyponatremia is a common electrolyte disturbance in elderly critical patients and one of the complications in common critical geriatric illnesses. The incidence of hyponatremia in the elderly is higher in internal medicine and neuroscience diseases such as heart failure,severe pneumonia,chronic obstructive pulmonary disease and acute or chronic cerebral vascular disease,which normally suggests poor prognosis. Physiopathologic mechanism of hyponatremia in the elderly patients is a result of concurrent mechanisms whereas mechanism of neurosurgical ones are cerebral salt wasting syndrome and syndrome of inappropriate antidiuretic hormone. Diuretics are the most common cause of hyponatremia,and the symptoms of hyponatremia in the elderly patients are often unobservable or even insidious and need closely monitoring.