脑性耗盐综合征  

Cerebral salt wasting syndrome

作　　者：李鹏 Li Peng(The First Affiliated Hospital of Gannan Medical College,Ganzhou,Jiangxi 341000)

机构地区：[1]赣南医学院第一附属医院,江西赣州341000

出　　处：《基层医学论坛》2022年第22期121-125,共5页The Medical Forum

摘　　要：脑性耗盐综合征(CSW)是中枢性低钠血症的重要原因之一,主要发生于动脉瘤性蛛网膜下腔出血、颅脑创伤、脑卒中、颅内感染和脑肿瘤术后,其临床特征为低钠血症、尿钠过度排泄、尿量增多、尿渗透压升高和低血容量。目前CSW的病理生理机制尚不完全清楚。诊断CSW有时具有很大的挑战性,尤其是缺乏显著低血容量征象的CSW不易与抗利尿激素分泌异常综合征(SIADH)鉴别,二者有很多相似临床特征和实验室检查,但治疗截然不同,误诊误治可能造成严重后果。补液和补钠是CSW的最基本治疗,盐皮质激素在减少尿钠排泄、维持血容量中具有重要的作用,已成为难治性CSW的一线治疗方法。本文就CSW的流行病学、诊断及治疗进行综述。Cerebral salt wasting syndrome(CSW)is the important cause of centr-al hyponatremia,which mainly occurs after spontaneous subarachnoid hemorrhage,traumatic brain injury,stroke,intracranial infection and brain tumor surgery.Theclinical features of CSW are hyponatremia,excessive urinary excretion of sodi-um,increased urine output,elevated urine osmotic pressure,and hypovolemia.The pathogenesis of this disorder is still not completely understood.Diagnosing CSWis sometimes very challenging,especially when it lacks significant signs of hy-povolemia,difficult to distinguish it from the more familiar syndrome of inap-propriate antidiuretic hormone(SIADH),because the two diseases have many overlapping clinical features and laboratory fifindings,but the proper treatment for each disease is different,and erroneous diagnosis could endanger the pati-ent.The mainstay of therapy for CSW is replacement of the sodium and water.Min-eralocorticoids play an important role in reducing urinary excretion of sodium-and restoring intravascular volume,and have become the first-line treatment forrefractory CSW.This article reviews the epidemiology,diagnosis and treatment of CSW.

关 键 词：低钠血症 脑性耗盐综合征 抗利尿分泌异常综合征 流行病学 诊断 治疗 

分 类 号：R3[医药卫生—基础医学]