颞叶型小脑幕切迹疝对颅脑损伤并发脑耗盐综合征诊治的影响  

Effect of transtentorial herniation on the diagnosis and treatment of craniocerebral injury complicated with cerebral salt wasting syndrome

作　　者：李爱民 刘虓 朱安林 LI Ai-min;LIU Xiao;ZHU An-lin(Department of Neurosurgery,Civil Aviation General Hospital,Beijing 100123,China)

机构地区：[1]民航总医院神经外科,北京100123

出　　处：《川北医学院学报》2021年第1期80-82,共3页Journal of North Sichuan Medical College

基　　金：民航总医院科研项目(201935)。

摘　　要：目的:探讨颞叶型小脑幕切迹疝对颅脑损伤并发脑耗盐综合征(CSWS)发生、发展、治疗时间及预后的影响。方法:回顾性分析46例颅脑损伤并发CSWS患者的临床资料,按是否发生颞叶型小脑幕切迹疝分为脑疝组(n=28)和非脑疝组(n=18),比较两组低钠血症发生时间、最低中心静脉压值、最低血钠值、最高24 h尿钠值、最大24 h尿量、血钠恢复正常所需时间及预后评分的差异。结果:脑疝组发生CSWS的时间早于非脑疝组,最低中心静脉压、最低血钠值低于非脑疝组,最高24 h尿钠值、最大24 h尿量高于非脑疝组,血钠恢复正常所需时间长于非脑疝组,且患者预后更差,差异具有统计学意义(P<0.05)。结论:颅脑损伤后颞叶型小脑幕切迹疝形成的患者出现CSWS的时间更早,症状更重,治愈时间更长,且预后更差,需密切监测血钠、尿钠、尿量、中心静脉压变化,力争早发现、早诊断和早治疗。Objective:To investigate the effects of transtentorial herniation on the occurrence,development,treatment time and prognosis of cerebral salt wasting syndrome(CSWS)complicated by craniocerebral injury.Methods:The clinical data of 46 patients with craniocerebral injury complicated with CSWS were retrospectively analyzed.According to whether complicated with transtentorial herniation,these patients were divided into cerebral hernia group(n=28)and non-cerebral hernia group(n=18).The differences in the occurrence time of hyponatremia,the lowest central venous pressure value,the lowest serum sodium value,the highest 24 h-urine sodium output,the maximum 24 h-urine volume,the time required for serum sodium value to return to normal,and the prognosis score between the two groups were compared.Results:CSWS occurred earlier in the cerebral hernia group than in the non-cerebral hernia group,the lowest central venous pressure and the lowest serum sodium value were lower than that in non-cerebral hernia group,the highest 24-hour urine sodium output and the maximum 24 h-urine volume were higher than that in the non-cerebral hernia group.The time required for the serum sodium to return to normal was longer than that in non-cerebral hernia group,and the prognosis of patients was worse,and the differences were statistically significant(P<0.05).Conclusion:Patients with transtentorial herniation after craniocerebral injury have earlier onset of cerebral salt wasting syndrome,more severe symptoms,longer cure time,and worse prognosis,so it is necessary to closely monitor the changes in serum sodium,urine sodium,urine volume and central venous pressure and strive for early detection,early diagnosis,and early treatment.

关 键 词：颅脑损伤 颞叶型小脑幕切迹疝 脑耗盐综合征 

分 类 号：R651.15[医药卫生—外科学]