114例多发伤合并低钠血症临床分析

目的 探讨多发伤舍并低钠血症的病因、发病机理、诊断和治疗。方法 回顾性总结114例多发伤合并低钠血症患者的临床表现、实验室检查结果，分析病因、分型和治疗方法。结果 114例患者中，39例（34．2％）因外伤后血浆大量丢失或强力利尿致血钠丢失过多引起，6例（5．3％）固外伤后长时间禁食及不恰当补液致血钠摄入不足引起，9例（7．9％）系外伤后高血糖或应用甘露醇等引起高渗性低钠，SIADH28例（24．6％），CSWS23例（20．1％），肾功能不全等9例（7．9％）。在治疗原发病的基础上，针对上述因素分别采用补充钠盐，补充血吝量，限制液体入量，应用激素等不同治疗方法，110例（96，5％）得到纠正。4例（3，5％）死亡，取得良好效果。结论 在治疗多发伤同时，应注意低钠血症发生的相关因素，做到早发现、早治疗以免产生严重后果。

Clinical observation of 114 cases hyponatremia with multiplelnjury

objective To assess the etiology,pathogenesis, diagnosis and treatment of hyponatremia with multiple injury.Methods To analyse clinical manifestation and its laboratory examination results of 114 patients with hyponatremia and multiple injury retrospectively and they were divided into different hyponatremia types and give corresponding treatment according to their etiological factors. Results Thirty nine (34.2%)cases of all patients were due to great quantity of plasma loss or diuretics utilization after external injury leading to hyponatremia, 6 cases(5.3%) owe to long time fasting diet and unfit fluid infusion after external injury, 9 cases(7.9%) hyperglycosemia or infusing mannitol leading to hypertonicity hyponatremia, 28 cases(24.6%) with SIADH(syndrome of inappropriate antidiuretic hormone secretion), 23 cases(20.1%) with CSWS(cerebral salt wasting syndrome) and 9 cases(7.9%) with renal inadequacy.110 cases(96.5%)with hyponatremia were cured, but 4 cases were dead by treating protopathy and correcting unfit factors leading to hyponatremia. Conclusions When dealing with multiple injuries, you must notice corresponding factors leading to hyponatremia as to diagnose and treat them in time lest it cause serious consequence.