颅脑损伤并发抗利尿激素异常分泌综合征机制和临床分析

Mechanism and Clinical Analysis of Syndrome of Inappropriate Secretion of Antidiuretic Hormone with Brain Injury

目的 :探讨颅脑损伤并发抗利尿激素异常分泌综合征 (SIADH)机制 ,临床特征及治疗转归。方法 :回顾分析总结 1992年 1月～ 2 0 0 1年 2月我院收治的 2 3例颅脑损伤并发SIADH资料。 2 3例均有临床表现、CT及实验室检查完整资料。结果 :2 3例均有不同程度的脑挫裂伤和低钠、低氯血症、低渗血症及高尿钠症。其中 19例早期诊断 ,预后好。 4例误诊误治 ,预后差。结论 :SIADH是由于下丘脑直接或间接损伤所致。临床特征为难以纠正的低钠、低渗血症。治疗关键是严控摄入水量 ,适量补盐 ,将血钠控制在安全水平 (12 5mmol/L)以上。

Objective: To analyze the cause, the clinical feature and treatment of syndrome of inappropriate secretion of antidiuretic hormone (SIADH) with brain injury. Methods: Retrospective cohort study enrolled 13 patients who were treated for SIADH with brain injury between Jan. 1992 and Feb. 2001 at our hospital. Data regarding medical history, CT-scan result and laboratorial data of the 23 patients, were collected. Results: The 23 patients all had different extent in brain contusion, hyponatremia, low serum chlorine, hyposmolality and high urine soduim. Because of having undergone diagnosis and treatment correctly, there were 19 patients whose clinical outcomes were favourable. The remainders, who were misdiagnosed and treated erroneously, achieved unsatisfactory outcome. Among them, one patient restored to health, one died and the other two recovered rather slowly. Conclusion: SIADH is caused by injury to the hypothalamus directly and/or indirectly. Clinical feature is irreformable hyponatremia and hyposmolality. The crux of therapy is that patients should be controlled with vigorous water restriction and be given sodium properly. The goal serum sodium level (>125 mmol/L) should be safety.