颅脑损伤病人抗利尿激素与低钠血症的相关性研究

CORRELATION BETWEEN ANTIDIURETIC HORMONE AND HYPONATREMIA IN PATIENTS WITH CRANIOCEREBRAL INJURY

目的 探讨颅脑损伤病人发生低钠血症的病因及预治措施。方法 随机对 75例单纯颅脑损伤病人分别于伤后 1d、7d、14d、2 1d对血浆抗利尿激素 (ADH)进行测定 ,对 4 3例颅脑损伤并发低钠血症的病人血浆中ADH、BUN、Cr及 2 4h尿钠进行测定 ,所得数据进行统计学分析。结果 颅脑损伤后 1d、7d、14d三组中ADH含量明显高于对照组 (P <0 .0 1) ,伤后第 2 1天病人ADH含量较对照组差异无显著性 (P >0 .0 5 )。颅脑损伤并发低钠血症的病人中 ,应用脱水药组血ADH与对照组无差异性 (P >0 .0 5 ) ,ADH与血浆中Na+ 浓度无相关性 (r =0 .2 0 ) ;停用脱水药出入量平衡组及停用脱水药 ,但出量大于入量组病人血浆中ADH较对照组均有明显差异 (P <0 .0 1) ,前者血浆中ADH水平明显高于对照组 ,与血Na+ 浓度呈负相关 (r = 0 .67) ,后者血浆中ADH水平明显低于对照组 ,与血Na+ 浓度呈正相关 (r =0 .87)。三组低钠血症病人 2 4h尿钠均明显高于对照组(P <0 .0 1)。结论 ADH在颅脑损伤不同时期低钠血症的发生过程中所起的作用不同 ,营养性低钠血症是导致颅脑损伤发生低钠血症的主要原因 ,SIADH、CSWS、外伤性尿崩是其重要原因 。

Objective To explore the causes and the prevention and treatment measures.Methods The antidiuretic hormone(ADH) of 75 cases of randomly selected simple craniocerebral injury was determined on the 1st,7th,14th and 21st day after injury.The ADH,BUN,Cr and the urine sodium in the patients of craniocerebral injury combined with hyponatremia were detected.All the data were analyzed statistically.Results The content of ADH on the 1st,7th and 14th day in the treatment group was found higher than that in the control group(P<0.01),while the content of ADH showed no significant difference on the 21st day between the two groups(P>0.05).There existed no correlation between the concentration of sodium and ADH(r=0.20).There existed significant difference between the levels of ADH being more than intake volume in the group of intake and output volumes being balanced and in the group of output volume being more than intake volume and that in the control group (P<0.01) after stopping using of dehydrant.The former group showed much higher level of ADH than the control group and had negative correlation to serum sodium concentration(r=-0.67),while the later group showed much lower level of ADH than the control group and had positive correlation to serum sodium concentration(r=0.87).The levels of urine sodium in all patients with hyponatremia were found much higher than those in the control group(P<0.01).Conclusion ADH plays different roles in the occurrences of hyponatremia at different times.Besides SIADH,CSNS and traumatic diabetes,nutritious hyponatremia is the leading cause of craniocerebral hyponatremia,and dehydrating drug is the predisposing cause of early craniocerebral hyponatremia.