神经外科低钠血症的临床分析

目的：探讨神经外科颅脑损伤患者低钠血症的发病机理、诊断及治疗方法。方法：回顾性分析700例颅脑损伤合并低钠血症患者的实验室检测结果，将患者分为轻-中型组360例，重型组340例，并与对照组比较，分析各组特征。重度颅脑损伤患者中由CSWS所致62例、SIADH所致40例，比较两者各指标的差异。结果：重型组和轻-中型组的血钠、尿钠及尿渗透压与对照组比较差异均有统计学意义（P〈0.05）；且前两组间比较差异均有统计学意义（P〈0.05）。CSWS组与SIADH组的发病时间，红细胞压积及血红蛋白浓度比较差异均有有统计学意义（P〈0.05）。结论：颅脑损伤患者常发生低钠血症。重度颅脑损伤患者的血钠降低、尿钠及尿渗透压升高更明显。重度颅脑损伤可由SIADH和CSWS导致，在治疗上SIADH需要限水，CSWS需要补充血容量及丢失的钠盐。

The Clinical Analysis of Hyponatremia in Neurosurgical Patients with Craniocerebral Injury

Objective：To explore the etiopathogenesis,differential diagnosis and management principles of hyponatremia in the neurosurgical patients.Method：The clinical data of 700 cases of craniocerebral injury and hyponatremia in our hospital was analyzed retrospectively,they were divided into the light-medium group（n=360）and the severe group（n=340）,and compared with the control group,the characteristic of each group was analyzed. The patients with severe craniocerebral injury caused by CSWS in 62 cases,40 cases caused by SIADH,the difference of every index was compared.Result：Blood sodium,urine sodium and osmotic pressure of the severe group and the light-medium group had statistically significant difference compared with the control group（P〈0.05）;and had statistically significant difference between the two groups（P〈0.05）. The disease time,hematocrit and hemoglobin concentration of the CSWS group and the SIADH group had significant difference（P〈0.05）. Conclusion：Hyponatremia can be easily found in patients with craniocerebral injury. Severe craniocerebral injury patients with reduced blood sodium and urine sodium and urine osmotic pressure rise more obvious.The severe craniocerebral injury are due to CSWS and SIADH,and restricting liquid infusion is the effective measure of treating the patients with SIADH,but the primary treatment for CSWS is water and salt replacement.