重型颅脑损伤后脑性盐耗综合征的诊治  

Diagnosis and treatment of cerebral salt wasting syndrome in severe craniocerebral injury

作　　者：朱飚[1] 胡未伟[2] 陈立峰[3] 黄礼明[1] 吴旭[1] 王卫余[1] 卢刚[1] 陈书达[1] 

机构地区：[1]浙江省人民医院神经外科,杭州310014 [2]浙江大学医学院附属二院神经外科 [3]浙江大学医院外科

出　　处：《中华急诊医学杂志》2006年第2期156-159,共4页Chinese Journal of Emergency Medicine

摘　　要：目的探讨重型颅脑损伤并发脑性盐耗综合征(CSWS)的发病机制、诊断和处理原则,以期提高疗效。方法对本院1994-2004年间收治的25例重型颅脑损伤并发脑性盐耗综合征患者的临床资料进行回顾性分析。结果并发CSWS的25例患者全部根据检测结果接受补液补钠治疗,同时给予适量的抗利尿激素和盐皮质激素。25例中4例死亡,其中2例死于严重的脑干损伤,1例死于继发性呼衰,1例死于心衰;21例血钠恢复至正常范围(140±5)mmol/L,治疗后血钠浓度较治疗前明显升高[(124.9±3.1)mmolLvs.(142.6±5.5)mmol/L,P<0.01],无补液补钠治疗相关的并发症发生。原发脑损伤越重,CSWS持续时间越长(P<0.01)。结论重型颅脑损伤特别是发生于下丘脑、三脑室旁损伤易出现脑性盐耗综合征并具有时限性,在积极治疗重型颅脑损伤的同时监测血钠、中心静脉压、血渗透压、尿钠及尿量具有重要意义。及时补液补钠可有效纠正低血纳和血容量不足。CSWS与抗利尿激素分泌不当综合征(SIADH)的治疗完全不同,评估有效动脉血容量(EABV)有助于二者的鉴别。Objective To investigate the pathogenetic mechanism, diagnosis and treatment of the cerebral salt wasting syndrome （CSWS） in severe cranioeerebral injury. Methods The daa of 25 CSWS patients with severe craniocerebral injury, who were admitted to our hospital from 1994 to 2004, were retrospectively analyzed. Results All the patients received water and salt replacement, antidiuretic hormone and mineralocortieoid, four patients died, two died from severe brain stem injury, one died from secondary respiratory failure, and one died from heart failure. Serum sodium levels returned to normal in 21 patients, with （ 140 ± 5） mmol/L. The mean serum sodium level was higher after treatment than before treatment the mean level of pretrement [ （ 124.9 ± 3.1 ） mmol/L vs. （ 142.64 ± 5.5） mmol/L, P 〈 0.01 ]. The severer the brain damage, the longer CSWS lasted （ P 〈 0.01 ）. Conclusion Patients with severe craniocerebral injury, specifically those with hypothalamic or third ventricle injury, are susceptible to be complicated with CSWS. It is important that serum sodium, central venous pressure, blood osmotic pressure, urine sodium and urine output should be monitored regularly during treatment of severe craniocerebral injury. Effective arterial blood volume （EABV） can severe as an index distinguishing inappropriate antidiuretic hormone secretion and CSWS.

关 键 词：颅脑损伤 低钠血症 脑性盐耗综合征 抗利尿激素分泌不当综合征 

分 类 号：R651.15[医药卫生—外科学] R651.150.2[医药卫生—临床医学]