颅脑损伤并发脑性盐耗综合征的临床分析

目的探讨颅脑损伤并发脑性盐耗综合征的临床表现特点与治疗方法。方法回顾性分析我科近15年收治的932例颅脑损伤病人影像与血生化资料。结果932例颅脑损伤中9例合并脑性盐耗综合征。9例入院时格拉斯（GCS）评分均在8分以下。伤后7-11 d开始出现低钠血症症状。6例病人出现精神症状和意识状态改变。其中7例病人意识障碍加深,并出现再次昏迷。9例病人血钠均低于130 mmol/L,其中3例病人低于120 mmol/L,所有病人血浆抗利尿激素（ADH）值小于15 pg/mL,血浆渗透压高于270 mOsm/L,尿钠均大于80 mmol/d,其中2例高于200 mmol/d。治愈7例,死亡2例。结论颅脑损伤并发的脑性耗盐综合征的发病机制与治疗措施不同于抗利尿激素分泌异常综合征,早期诊治能降低颅脑损伤病人的病残率和病死率。

Clinical analysis of craniocerebral injury with cerebral salt wasting syndrome

Objective To explore the clinical features and treatment methods of craniocerebral injury with cerebral salt wasting syndrome.Methods Totally 932 patients with craniocerebral injury were retrospectively analyzed in our department in the last 15 years,including the screenage and biochemistry data.Results In 932 cases,only 9 cases were found with cerebral salt wasting syndrome and which got less than 8 score according GSC.Hyponatremia happened on the 7th to 11th days after injury.Their serum sodium were lower than 130 mmol/L,3 cases were lower than 120 mmol/L.All their antidiuretic hormone(ADH) was lower than 15 pg/mL,plasma osmotic pressure was over 270 mOsm/L,and urine sodium was over 80 mmol/d,2 cases were exceed 200 mmol/d.Seven patients cured and 2 patients died.Conclusion The pathogenesis and management of syndrome of cerebral salt wasting syndrome complicated in craniocerebral injury are different from that of syndrome of inapprpriate antidiuretic hormone secretion.Early diagnosis and therapy could reduce the morbidity and mortality.