低钠血症对终末期肝病患者多器官毒性作用与临床经验

Clinical experience on multi-organ toxicity of hyponatremia in patients with end-stage liver disease

低钠血症对终末期肝病患者多器官毒性作用是指在非病理条件下血清钠、氯丢失及渗透压下降,肾素-血管紧张素-醛固酮系统、血管升压素、内皮素及B型利钠肽等血管活性物质合成与释放增加或失衡,内源性与外源性血管活性物质抵抗、酸碱平衡失调及低氮性碱中毒,并导致心脏、血管兴奋性及心脏射血分数下降,有效循环血容量减少等诱发的心脏与周围循环功能衰竭、肝肾综合征、肝性脑病、低渗性脑病,称为低钠血症毒性作用。该文就低钠血症对终末期肝病患者多器官毒性作用的原因及发病机制、诊断与治疗问题提出商榷。

The multi-organ toxic effects of hyponatremia on patients with end-stage liver disease refers to the loss of serum Na+,Cl-and the decrease of osmotic pressure under non pathological conditions,the increase or imbalance in the synthesis and release of vasoactive substances such as renin angiotensin aldosterone system,antidiuretic hormone,endothelin and B-type natriuretic peptide,endogenous and exogenous vasoactive substance resistance,acid-base imbalance and hypochloric alkalosis.It also leads to heart and peripheral circulatory failure induced by decreased cardiac and vascular excitability,decreased cardiac ejection fraction,and decreased effective circulating blood volume.Hepatorenal syndrome,hepatic encephalopathy,and hypotonic encephalopathy are hyponatremia toxic effects on end-stage liver disease patients.This study discusses the causes,pathogenesis,diagnosis and treatment of multiple organ toxicity of hyponatremia to end-stage liver disease.