颅脑手术围术期并发低钠血症的处理及文献综述  

Management of Hyponatremia during Perioperative Period of Craniocerebral Operation and Literature Review

作　　者：张静 舒仕瑜 

机构地区：[1]重庆医科大学附属第二医院麻醉科,重庆

出　　处：《临床医学进展》2023年第3期4623-4630,共8页Advances in Clinical Medicine

摘　　要：低钠血症是颅脑手术常见的并发症,其发病率较高,尤其在蛛网膜下腔出血、创伤性脑损伤(TBI)、垂体肿瘤患者中常见,并且低钠血症具有显著增加并发症的发病率和死亡率的风险。在颅内疾病患者中脑出血体积、脑损伤程度、脑水肿等被认为是导致低钠血症的主要因素,其临床表现主要与血清钠浓度下降的严重程度和剧烈程度有关。目前公认的导致低钠血症两种机制:即抗利尿激素分泌不当综合征(SIADH)和脑性盐耗综合征(CSWS),这两种机制的本质区别是容积状态:SIADH涉及高容量低钠血症,而CSWS则表现为低容量低钠症。对于低钠血症的处理应针对血浆钠浓度降低的原因进行治疗,将对低钠血症的纠正更有效。Hyponatremia is a common complication of craniocerebral surgery with a high incidence, especially in patients with subarachnoid hemorrhage, traumatic brain injury (TBI), and pituitary tumors. Moreover, hyponatremia significantly increases the risk of morbidity and mortality of complications. In patients with intracranial diseases, the volume of cerebral hemorrhage, the degree of brain inju-ry, cerebral edema are considered to be the main factors leading to hyponatremia, and its clinical manifestations are mainly related to the severity and intensity of the decrease in serum sodium concentration. There are currently two recognized mechanisms leading to hyponatremia: syndrome of inappropriate antidiuretic hormone secretion (SIADH) and cerebral salt wasting syndrome (CSWS). The essential difference between the two mechanisms is the volume state: SIADH involves high volume hyponatremia, while CSWS presents with low volume hyponatremia. The treatment of hyponatremia should be targeted at the cause of the decrease in plasma sodium concentration, which will be more effective in correcting hyponatremia.

关 键 词：低钠血症 蛛网膜下腔出血 创伤性脑损伤 抗利尿激素分泌不当综合征(SIADH) 脑性盐耗综合征(CSWS) 

分 类 号：R65[医药卫生—外科学]