创伤性颅脑损伤并发抗利尿激素分泌不当综合征与脑耗盐综合征的相关危险因素分析

Risk factors of traumatic brain injury complicated syndrome of inappropriate antidiuretic hormone and cerebral salt wasting syndrome

目的探讨创伤性颅脑损伤(TBI)后发生抗利尿激素分泌不当综合征(SIADH)与脑耗盐综合征(CSWS)的相关危险因素及其差异性。方法回顾性分析1015例创伤性颅脑损伤患者的临床资料,其中发生低钠血症的334例(钠摄入不足23例,利尿剂过度使用16例,SIADH 135例,CSWS 160例)。对334例患者的一般情况、损伤类型及部位和是否手术等行单因素分析和多因素Logistic回归分析。结果TBI患者发生SIADH与额部损伤、颞部损伤、脑挫伤、急性硬膜外出血、弥漫性轴索损伤、颅底骨折相关(P<0.05),且颞部损伤、脑挫伤、急性硬膜外出血、弥漫性轴索损伤、颅底骨折是其独立危险因素。TBI患者发生CSWS与GCS≤8分、颞部损伤、枕部损伤、创伤性蛛网膜下出血、急性硬膜下出血、弥漫性轴索损伤、颅底骨折和是否手术相关(P<0.05),且GCS≤8分、颞部损伤、创伤性蛛网膜下出血、急性硬膜下出血、弥漫性轴索损伤、颅底骨折、手术是其独立危险因素。结论颞部损伤、弥漫性轴索损伤、颅底骨折是SIADH和CSWS的共同独立危险因素。脑挫伤、急性硬膜外出血是SIADH的独立危险因素,GCS≤8分、创伤性蛛网膜下出血、急性硬膜下出血、手术是CSWS的独立危险因素,两者在以上相关因素中有明显的差异性。有易于临床上针对这些危险因素早期诊断低钠血症的类型,及时干预,从而改善TBI患者的预后。

Objective To explore the risk factors and differences of syndrome of inappropriate antidiuretic hormone(SIADH) and cerebral salt wasting syndrome(CSWS) after traumatic brain injury(TBI). Methods The clinical data of 1 015 patients with TBI were analyzed retrospectively, including 334 of hyponatremia(23 of insufficient sodium intake, 16 of overuse of diuretics, 135 of SIADH, 160 of CSWS). Univariate analysis and multivariate logistic regression analysis were performed on the general condition of 334 patients, the type and location of injury and whether surgery were performed. Results The incidence of SIADH in patients with TBI was associated with frontal injury, temporal injury, brain contusion, acute epidural hemorrhage, diffuse axonal injury and skull base fracture. Temporal injury, brain contusion, acute dural extradural hemorrhage, diffuse axonal injury and skull base fracture were independent risk factors(P<0.05). CSWS was associated with GCS≤8, temporal injury, occipital injury, traumatic subarachnoid hemorrhage, acute subdural hemorrhage, diffuse axonal injury, skull base fracture and operation in patients with TBI(P<0.05). GCS≤8, temporal injury, traumatic subarachnoid hemorrhage, acute subdural hemorrhage, diffuse axonal injury, skull base fracture and operation were independent risk factors. Conclusions Temporal injury, diffuse axonal injury and skull base fracture are common and independent risk factors for SIADH and CSWS. Cerebral contusion and acute epidural hemorrhage were independent risk factors of SIADH. GCS≤8, traumatic subarachnoid hemorrhage, acute subdural hemorrhage and operation were independent risk factors of CSWS. It is easy to diagnose the type of hyponatremia early according to these risk factors and intervene in time so as to improve the prognosis of patients with TBI.