肝硬化腹水合并低钠血症补充钠盐治疗的临床意义  

Clinical significance of supplementing sodium to liver cirrhotic ascites patients with hyponatremia

作　　者：吴景迪[1] 张琴[1] 肖宏[1] 魏万清[1] 沈芳[1] 

机构地区：[1]上海市公共卫生临床中心复旦大学附属公共卫生临床中心肝炎科,上海201508

出　　处：《内科理论与实践》2009年第2期118-120,共3页Journal of Internal Medicine Concepts & Practice

摘　　要：目的:探讨对肝硬化腹水合并低钠血症患者积极补充钠盐治疗的临床意义。方法:测定120例肝硬化腹水低钠血症患者的血钠水平,并依结果将患者分为轻、中、重度低钠血症组,分析其并发症的发生率。根据患者血钠水平,在综合治疗和利尿的基础上补充氯化钠,观察治疗后病情的转归情况。结果:轻、中、重度低钠血症组合并低渗性脑病的发生率分别为0%、10.4%和37.5%,肝肾综合征的发生率分别为0%、8.2%和25.0%,合并顽固性腹水的发生率分别为7.5%、20.8%和43.8%。积极补充钠盐后,随血钠浓度的提高,患者24h尿量显著增加,腹水明显消退,低渗性脑病症状明显减轻或消失,肾功能明显好转。结论:肝硬化腹水合并低钠血症患者并发症的发生率与血钠水平呈负相关,适当及时补充钠盐是重要的辅助治疗措施,有利于腹水的消退及临床症状的改善。Objective To investigate the clinical significance of supplementing sodium to liver cirrhotic ascites patients with hyponatremia. Methods Blood sodium level was determined in 120 cirrhotic ascites patients with hyponatremia. The patients were divided into mild, moderate and severe hyponatremia groups according to the blood sodium level and the incidence rate of complication was analyzed. Sodium chloride was supplemented on the basis of comprehensive and diuretic therapy, and the outcomes of these patients were analyzed. Results The incidence rates of hypo-osmotic encephalopathy in mild, moderate and severe hyponatremia groups were 0%,10.4% and 37.5%,respectively; the incidence rates of hepato-renal syndrome were 0%,8.2% and 25.0%, respectively; and the incidence rates of refractory ascites were 7.5%,20.8% and 43.8%, respectively. As the level of blood sodium was elevated after the supplementation of sodium, 24 hour urine volume increased and ascites regressed significantly, symptoms of encephalopathy eased or disappeared and renal function improved significantly. Conclusions The incidence of complication in the liver cirrhotic ascites patients with hyponatremia correlates negatively with the blood sodium level. Appropriate supplementation of sodium salt is an important adjuvant therapeutic measure and is in favor of the regression of ascites and improvement of clinical symptoms in the liver cirrhotic patients with hyponatremia.

关 键 词：肝硬化 腹水 低钠血症 低渗性脑病 

分 类 号：R575.2[医药卫生—消化系统] R591.1[医药卫生—内科学]