颅脑损伤后低钠血症的临床特点分析及诊治

Clinical characteristics,diagnosis and treatment of hyponatremia after traumatic brain injury

目的研究颅脑损伤后低钠血症的病因、发病机制、临床特点及治疗。方法回顾性分析我科近5年收治的137例颅脑损伤后低钠血症的临床表现、实验室检查,分析其临床特点,总结其诊治经验。结果颅脑损伤后低钠血症主要分为脑性盐耗综合征(CSWS)和抗利尿激素分泌异常综合征(SIADH),均具有低钠血症、意识障碍、头痛头晕及恶心呕吐等特点,但CSWS患者血容量不足,中心静脉压降低,SIADH患者血容量升高,中心静脉压升高。本组患者治愈123例,死亡14例。结论颅脑损伤低钠血症发病机制与治疗措施有所不同,中心静脉压监测可鉴别CSWS和SIADH,限水补钠等诊断性治疗措施是鉴别CSWS和SIADH最简捷有效的方法,早期诊治能降低颅脑损伤患者的病残率和死亡率。

Objective The etiology, pathogenesis, clinical features and treatment of hyponatremia in patients with traumatic brain injury were discussed. Methods The clinical manifestations, laboratory tests and clinical features of 137 cases with traumatic brain injury and hyponatrernia treated in the past five year were analyzed retrospectively and the diagnosis and treatment of the patients were discussed. Results Hyponatremia after traumatic brain injury was divided into cerebral salt wasting syndrome （CSWS） and syndrome of inappropriate antidiuretic hormone secretion （SIADH） with the symptoms such as hyponatremia, unconsciousness, headache, dizziness, nausea and vomiting, etc. However, hypovolemia and decreased central venous pressure occurred in CSWS patients, and the increased blood volume and increased central venous pressure were observed in SIADH patients. In this group 123 patients were cured and 14 died. Conclusion The pathogenesis and treatment of hyponatremia in patients with traumatic brain injury is different, and central venous pressure monitoring can identify CSWS and SIADH. Water restrictions and salt supplement are the most simple and effective methods to identify CSWS and SIADH. Early diagnosis and treatment can reduce the morbidity and mortality of these patients.