重型颅脑损伤并发中枢性低钠血症临床分析

目的 总结分析重型颅脑损伤后中枢性低钠血症的临床特点、诊断和治疗.方法 回顾性分析我科2009-2011年收治的25例重型颅脑损伤并发低钠病人临床表现和血、尿电解质、渗透压等的检测结果.结果 本组均有相似的临床表现和实验室检查,其中16例符合抗利尿激素分泌异常综合征(syndrome of inappropriate antidiuretic hormone secretion,SIADH),其中治愈15例,死亡1例;9例颅脑损伤符合脑性耗盐综合征(cerebral salt wasting syndrome,CSWS),治愈9例,无死亡病例.结论 重型颅脑损伤后中枢性低钠血症有CSWS和SIADH两类,SIADH血容量增加,限水治疗有效;CSWS血容量减少,补钠、补液治疗有效.     

重型颅脑损伤抗利尿激素异常分泌综合征临床分析

目的探讨重型颅脑损伤患者并发抗利尿激素异常分泌综合征（SIADH）的病因、发病机制、诊断及治疗。方法回顾性分析重型颅脑损伤后发生抗利尿激素异常分泌综合征36例，通过其临床表现及实验室指标明确诊断，确定有效的治疗方法。结果7例死亡，33例低钠血症恢复.结论低血钠、高尿钠、低血浆渗透压是SIADH的特点，治疗原则以限水为主。     

重型颅脑损伤后低钠血症42例诊治分析

目的：探讨重型颅脑损伤后低钠血症的治疗。方法回顾性分析42例重型颅脑损伤后并发低钠血症患者,根据中心静脉压和尿量、尿钠含量,分为抗利尿激素分泌异常综合征（SIADH）和脑性盐耗综合征（CSWS）和其他类型,并分别给予限水、补钠等治疗措施。结果 SIADH 12例全部治愈, CSWS 21例中18例治愈,3例在治疗过程中死亡,其他类型9例治愈。结论重型颅脑损伤后低钠血症原因不同,应根据不同类型给予相应治疗。     

颅脑损伤继低钠血症的原因探讨及护理措施

目的总结分析颅脑损伤继低钠血症的原因及护理。方法回顾性分析本科收治的65例颅脑损伤患者的临床资料。结果41例单纯性低钠血症患者经过治疗,低钠全部纠正,11例SIADH患者经严格限制入水量及积极治疗原发病,低钠纠正,8例CSWS患者经治疗,4例纠正,3例自动出院后死亡,1例在院死亡。5例尿崩症患者,经使用垂体后叶素、弥凝,低钠纠正。结论颅脑损伤继低钠血症的原因不同,所采取的护理措施也不同。     

重型颅脑损伤后中枢性低钠血症临床观察及治疗

目的探讨重型颅脑损伤后中枢性低钠血症的治疗方法及临床疗效。方法选取本院26例重型颅脑损伤后中枢性低钠血症的患者为研究对象,根据其临床特点及检查结果分为抗利尿激素分泌不当综合征（SIADH）5例和脑性盐耗综合征（CSWS）21例,给予相应的治疗,总结两组的治疗效果。结果 CSWS组的中心静脉压（CVP）、抗利尿激素（ADH）显著低于SIADH组,CSWS组血浆心钠素（ANP）值显著高于SIADH组,P〈0.05。26例患者中,有2例患者死亡,24例患者低钠血症得到纠正。结论 SIADH和CSWS是引起重型颅脑损伤后中枢性低钠血症的主要原因,应针对不同的病因采取有针对性的治疗,降低病死率。     

颈髓损伤继发低钠血症23例临床观察及治疗

目的 探讨颈髓损伤后继发低钠血症的机制及临床治疗方法.方法 对2000年1月至2010年12月收治的23例颈髓损伤继发低钠血症患者的临床资料进行回顾性分析.根据临床监测的血清钠、尿钠、血浆渗透压及尿液渗透压数值差异进行分组临床治疗.结果 7例治疗中采用限水、补钠治疗,16例经补液及扩容、补钠治疗均完好纠正低钠血癌.结论 颈髓损伤继发低钠血症的患者根据监测的临床数据分组并经正确补液及补钠治疗,可以纠正低钠或维持钠代谢的平衡.     

重型颅脑损伤后低血钠的监测治疗研究

目的：探讨颅脑损伤后并发低钠血症的病因、发病规律、监测及治疗。方法：回顾性分析1116例颅脑损伤合并低钠血症患者的临床资料与治疗方法。结果：所有患者在伤后或术后前4d出现低血钠例数较少,从第5天开始升高,第9天达到高峰。5～14d为低钠期,从15d后开始钠恢复正常,意识状态好转,以后无低钠血症发生。结论：颅底损伤颞底患者发生率高。以每天监测的血钠、血浆渗透压指导补钠更科学,血钠水平尽早恢复对患者恢复意识至关重要,是抢救重型颅脑损伤患者最重要的一环,是脑外科医师除手术外最重要影响预后的基本功。电解质紊乱关键在于早发现、早治疗,并不是不可战胜的疾病。     

颅脑损伤后中枢性低钠血症的诊治分析

目的探讨颅脑损伤后中枢性低钠血症的临床诊断及处理方法。方法回顾性分析我科2007年3月至2012年2月共收治的45例颅脑损伤后并发中枢性低钠血症患者临床资料。结果抗利尿激素分泌异常综合征(SIADH)16例中14例6~13d治愈,2例分别死于多器官功能衰竭和原发性颅脑损伤;脑性盐耗综合征(CSWS)29例中25例1~3周血钠恢复正常,4例死于广泛脑挫裂伤和原发性脑干损伤。结论 SIADH和CSWS发病机制不同,应在积极处理原发病的同时采取针对性治疗措施。     

重型颅脑损伤后低钠血症的治疗体会

低钠血症是颅脑损伤病人临床上常见的最严重的代谢紊乱之一,维持正常血钠对维持病人正常生理代谢至关重要。重型颅脑损伤并发低钠血症临床上并不少见,其主要原因存在两种机制:SIADH和CSW S。只有了解了患者发生低钠血症的病理生理学机制,才能纠正低钠血症。本科自1995年1月至20     

补钠在颅脑损伤后低钠血症患者中的疗效研究

目的探讨补钠对颅脑损伤后低钠血症患者的临床疗效。方法收集84例颅脑损伤后低钠血症患者为研究对象,将所选的患者分为两组。对照组患者进行常规的治疗;观察组患者通过补充高浓度的氯化钠进行治疗。然后比较两组患者血钠的纠正率、血钠恢复正常水平的时间、抗利尿激素分泌失调综合征(SIADH)的发生率、死亡率、满意度及患者血钠恢复后的复发率。结果患者血钠水平恢复的时间观察组明显短于对照组;满意度及治疗第5天后低血钠得到纠正的患者观察组明显均高于对照组;观察组患者血清钠纠正后的复发率及病死率均明显低于对照组;治疗过程中观察组患者SIADH的发生率观察组低于对照组,但两组患者间差异无统计学意义(P 0.05)。结论高浓度的氯化钠能快速恢复颅脑损伤后低钠血症患者血清中钠离子的正常水平,提高患者血钠的纠正率,降低患者血清钠纠正后的复发率及病死率,值得在临床治疗过程中大力推广应用。     

鞍区病变手术后低钠血症的诊断和治疗

目的 探讨鞍区病变手术后并发低钠血症的诊断和治疗方法。方法 回顾性分析我科2001年1月-2005年12月诊治的18例鞍区病变手术后并发低钠血症的临床资料。结果16例患者诊断为脑性盐耗综合症，2例诊断为抗利尿激素不适当分泌综合症。经相应治疗后，全部患者低钠血症纠正，恢复良好17例．自动出院1例。结论 鞍区病变手术后易发生低钠血症，中心静脉压监测对其诊治有指导意义。     

A novel vasopressin dual V1A/V2 receptor antagonist, conivaptan hydrochloride, improves hyponatremia in rats with syndrome of inappropriate secretion of antidiuretic hormone (SIADH)

We investigated the effects of intravenous administration of conivaptan hydrochloride, a dual vasopressin V1A and V2 receptor antagonist, on blood electrolytes and plasma osmolality in rats with an experimental syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The experimental SIADH rat model was developed by means of continuous administration of arginine vasopressin (AVP) via a subcutaneously implanted osmotic mini pump, and hyponatremia was induced by additional water loading. This model possesses similar characteristics to those observed in patients with SIADH, specifically decreases in blood sodium concentration and plasma osmolality. In this experimental model, intravenous administration of conivaptan (0.1, 1 mg/kg) significantly increased blood sodium concentration and plasma osmolality. On the other hand, intravenous administration of furosemide (10 mg/kg) did not increase either blood sodium concentration or plasma osmolality in the SIADH rats. Moreover, furosemide significantly lowered blood potassium concentration. These results show that conivaptan improves hyponatremia in rats with SIADH, supporting the therapeutic potential of conivaptan in treatment of patients with hyponatremia associated with SIADH.     

托伐普坦片治疗低钠血症的效果及安全性观察

目的观察托伐普坦片对抗利尿激素分泌不高(SIADH)及其它原因引起的非低容量性、非急性低钠血症患者的疗效及安全性。方法 38例因充血性心力衰竭、肝功能衰竭伴腹水形成、慢性肾功能不全或抗利尿激素分泌不当等疾病引起体液潴留和低钠血症的患者,予口服托伐普坦片治疗。结果口服托伐普坦片者都有血钠浓度和血渗透压的显著升高。结论托伐普坦片能够显示良好的提高血清钠浓度作用,对低钠血症患者有明显疗效。没有严重并发症和不良反应,临床应用中简便且安全。     

重型颅脑损伤合并低钠血症115例临床分析

目的探讨重型颅脑损伤合并低钠血症的诊治方法。方法对115例重型颅脑损伤合并低钠血症患者的临床诊治情况进行总结分析。结果营养性低钠血症70例,抗利尿激素异常分泌综合征14例,脑性耗盐综合征31例。营养性低钠血症和脑性耗盐综合征均给予补盐、补水治疗,抗利尿激素异常分泌综合征行限水治疗或限水补盐治疗。42例1周内纠正,29例2周内纠正,11例3周内纠正,5例4周内纠正,28例因病情较重死亡。结论临床上营养性低钠血症最常见,也最易纠正;抗利尿激素异常分泌综合征较少见,易误诊误治;营养性低钠血症和脑性耗盐综合征需要补液补盐治疗,而抗利尿激素异常分泌综合征则应该以限水治疗为原则。故要重视三者间的鉴别诊断,正确的诊断是治愈的关键。     

Management of the syndrome of inappropriate secretion of antidiuretic hormone

The etiology, pathophysiology, clinical features, diagnosis, and medical treatment of the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) are reviewed. SIADH is a common cause of hyponatremia in hospitalized patients. Increased concentrations of antidiuretic hormone (ADH) result in retention of free water, increased excretion of sodium, and hyponatremia. Symptoms generally occur only when hyponatremia is severe (less than or equal to 125 meq/L) and may include anorexia, vomiting, and confusion, followed by seizures, coma, and death. SIADH may result from a variety of diseases, as well as from the use of drugs such as chlorpropamide, carbamazepine, diuretics, and some antineoplastic agents. Diagnosis of SIADH is confirmed by demonstration of a high urine osmolality with a low plasma osmolality, in the absence of diuretic use. Immediate treatment of the symptomatic patient with SIADH includes intravenous furosemide and 3% sodium chloride injection to produce a negative free-water balance. If the underlying cause of SIADH cannot be corrected, the treatment of choice for chronic SIADH is fluid restriction. If this is not tolerated by the patient, demeclocycline can be used to induce a negative free-water balance. Urea, lithium, phenytoin, and loop diuretics have been reported to be effective, but there are few data to support their use. Future research into the treatment of SIADH must be directed at developing effective antagonists of ADH. Treatment of SIADH consists of elimination of underlying causes and restriction of fluid intake; if these measures are unsuccessful or poorly tolerated, long-term drug therapy may be indicated.     

鞍区肿瘤术后低钠血症的临床处理

目的 探讨鞍区肿瘤术后抗利尿激素分泌异常综合征(SIADH)及脑性盐耗综合征(CSWS)的鉴别诊断及治疗方法.方法回顾性分析86例首次接受鞍区肿瘤术后低钠血症患者的临床表现和实验室检查,总结有效的诊断及治疗方法.将48例垂体腺瘤患者分为A组,28例颅咽管瘤和10例脑膜瘤患者分为B组;CSWS低钠者补钠、迅速扩容、补充高...     

Methyldopa-induced syndrome of inappropriate antidiuretic hormone secretion and bone marrow granulomatosis

A case of an elderly man who developed severe hyponatremia and bone marrow granulomatosis while taking methyldopa is described. The hyponatremia was found to be due to the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Bone marrow biopsy revealed granulomas. A MEDLINE search of the English literature was done, yielding only one previous report of methyldopa-induced bone marrow granulomatosis and no previous reports of methyldopa-induced SIADH.     

Recent trends in pediatric fluid therapy

Virtually all hospitalized pediatric patients require some form of intravenous fluid administration. The foundation of current pediatric fluid therapy practice was formulated in the 1950s when pediatricians were dealing with relatively simple dehydration and normal homeostasis could largely be assumed. Recent advances in pediatric medicine have resulted in increased severity of illness and normal physiology can no longer be assumed. The traditional approach to pediatric fluid therapy has been recently challenged by the syndrome of inappropriate secretion of antidiuretic hormone (SIADH), cerebral salt wasting syndrome (CSWS), diabetic ketoacidosis (DKA) and hyponatremia caused by the inappropriate use of hypotonic solutions, all of which involve unusual sodium and serum osmolarity dynamics causing life threatening central nervous system (CNS) pathophysiology. In this review, we give an overview of the recent understanding of pediatric fluid therapy. The widespread use of acetate in place of lactate as a bicarbonate precursor and the expanding role of nonalbumin plasma expanders in pediatrics are also discussed as they will play a clinical role in the near future.     

托伐普坦治疗小细胞肺癌伴抗利尿激素异常分泌综合征所致的低钠血症

目的：观察托伐普坦治疗小细胞肺癌伴低钠血症的效果。方法：确诊小细胞肺癌伴抗利尿激素异常分泌综合征患者7例,均予以托伐普坦,每日口服1次：7.5 mg,前3天;15 mg,后4天,于第4天、第8天晨查血钠和体质量,并进行ECOG评分。结果：与治疗前比较,所有患者血钠均恢复正常,ECOG评分亦有显著改善,且体质量呈下降趋势。结论：托伐普坦应成为小细胞肺癌伴抗利尿激素异常分泌综合征所致的低钠血症患者的推荐用药。