重症颅脑损伤患儿低钠性多尿的原因分析及诊疗

Analysis of Causes and Diagnosis and Treatment of Hyponatremia Polyuria in Children with Severe Craniocerebral Injury

目的探讨重症颅脑损伤患儿低钠性多尿的原因及诊疗方法。方法回顾性分析湛江中心人民医院2013年1月—2018年7月收治的40例重症颅脑损伤后低钠血症患儿临床资料,分析其诊治过程,探讨其发病原因及治疗方法。结果20例诊断为脑性耗盐综合征(CSWS),10例诊断为中枢性尿崩(CDI),10例诊断为CSWS合并CDI。在积极治疗原发颅脑损伤的基础上,给予补液补钠、维持水电解质平衡、去氨加压素、氢化可的松等治疗,CSWS患儿中治愈18例(90.00%),死亡2例(10.00%),CDI患儿中治愈8例(80.00%),永久性尿崩未愈1例(10.00%),死亡1例(10.00%),CSWS合并CDI患儿中治愈7例,死亡3例。结论重症颅脑损伤患儿低钠性多尿原因有多种,应尽早监测血钠、24小时尿钠、血渗透压及尿液渗透压,辨明原因,对症治疗,可获得较好的预后。

Objective To investigate the causes and diagnosis and treatment of hyponatremia in children with severe craniocerebral injury.Methods The clinical data of 40 children with hyponatremia after severe craniocerebral injury in the hospital from January,2013to July,2018 were analyzed retrospectively.The diagnosis and treatment of hyponatremia were analyzed.The causes and treatment of hyponatremia were discussed.Results 20 cases were diagnosed as cerebral salt wasting syndrome(CSWS),and 10 cases were diagnosed as central urinary avalanche(CDI),10 cases were diagnosed as cerebral salt wasting syndrome(CSWS)combined with central urinary avalanche(CDI).On the basis of active treatment of primary craniocerebral injury,rehydration sodium,egiven to maintain water electrolyte balance,desaminopressin,hydrocortisone and so on were given to patients 18 cases(90.00%)with CSWS were cured,and 2 cases(20.00%)died.8 children with CDI were cured(80.00%).One case(10.00%)didn’t recovered from permanent urinal avalanche,one case died(10.00%),7 cases with CSWS combined with CDI were cured,and 3 cases died.Conclusion There are many reasons for hyponatremia polyuria in children with severe craniocerebral injury.It is necessary to monitor blood sodium,24 hours urine sodium,blood osmotic pressure and urine osmotic pressure as early as possible.