脑脊液渗透浓度测定在小儿急性脑水肿治疗中的应用和意义  

The role of osmolality monitoring on cerebrospinal fluid in children with acute brain edema.

作　　者：刘丽旭[1] 杨于嘉[1] 贾延吉[1] 尹飞[1] 王霞[1] 

机构地区：[1]中南大学湘雅医院儿科,长沙410008

出　　处：《中国实用儿科杂志》2002年第12期720-722,共3页Chinese Journal of Practical Pediatrics

基　　金：卫生部临床学科重点项目 (No .970 80 2 43 )

摘　　要：目的　探讨脑脊液渗透浓度监测在急性脑水肿患儿中的作用及其与预后的关系。方法　收集 5 6例诊断为急性脑水肿患儿的脑脊液标本共 115例次 ,同时采集血液做渗透浓度测定行相关分析。选择小儿正常脑脊液标本共 2 1例作为本方法测定的正常参考值。使用美国产微量渗透压仪 (Model 330 0 )测定渗透浓度。结果　① 2 1例小儿正常脑脊液参考值为 (2 84 8± 8 7)mmol/L ,5 6例急性脑水肿患儿共 115例次脑脊液标本渗透浓度范围 2 5 3～ 35 3mmol/L ;② 10例不同急性脑水肿患儿同一时间的血和脑脊液渗透浓度分别为 (2 92 2± 2 3 6 )mmol/L和 (2 90 4± 2 7 5 )mmol/L ,两者具有高度正相关 (r =0 933,P <0 0 1) ;③ 5例死亡患儿 (共 11例次 )的脑脊液渗透浓度为 (334 8± 16 5 )mmol/L ,与正常参考值比较差异有非常显著性意义 (P <0 0 1) ;当脑脊液渗透浓度超过 32 0mmol/L时 ,病死率明显增加 ;④结脑患儿治疗前脑脊液渗透浓度值为 (2 6 5 4± 11 1)mmol/L ,较正常参考值明显下降 ,差异有显著性意义 (P <0 0 5 ) ;经治疗后脑脊液渗透浓度上升至 (2 80 2± 15 9)mmol/L ,与治疗前比较差异有显著性意义 (P <0 0 5 )。结论　①脑脊液与血渗透浓度具有高度相关性 。Objective To explore the role of osmolality monitoring on cerebrospinal fluid(CSF)in children with acute brain edema.Methods Using the micro osmometer(the Advanced\+\{TM\} MICRO OSMOMETER,Model 3300),we determined CSF osmolality(115 cases)in 56 children with acute brain edema,and at the same time collected blood to exercise correlation analysis between CSF and blood osmolality.Results ①The normal levels of CSF osmolality in 21 healthy children were(284 8±8 7)mmol/L;The range of CSF osmolality in 56 children with acute brain edema was 253～353mmol/L;②There was a significantly positive correlation between serum osmolality and CSF osmolality (r=0 933,P<0 01).③The level of CSF osmolality in 5 dead children was(334 8±16 5)mmol/L,which was significantly higher than the normal(P<0 01);When the CSF osmolality was over 320 mmol/L,the mortality increased obviously.④The CSF osmolality in children with tuberculous meningitis before treatment was significantly lower[(265 4±11 1)mmol/L]than the normal(P<0 05),and it increased significantly after treatment[(280 2±15 9)mmol/L](P<0 05).Conclusion ①There is a significantly positive correlation between serum osmolality and that of CSF,therefore,we can continuously monitor serum osmolality instead of CSF osmolality.②The mortality of acute brain edema greatly increases when CSF osmolality is over 320mmol/L.Hyperosmotic dehydrant should be used carefully at this time.③The CSF osmolality in children with tuberculous meningitis before treatment was significantly lower than that of normal,which is perhaps due to cerebral salt wasting syndrome and dilutional hyponatremia.

关 键 词：脑脊液 渗透浓度 测定 小儿 急性脑水肿 治疗 

分 类 号：R742.7[医药卫生—神经病学与精神病学]