老年颅脑损伤后并发低钠血症的治疗体会

目的通过总结老年颅脑损伤后并发低钠血症患者的治疗体会,探讨老年患者颅脑损伤后并发低钠血症的病因、处理方法及治疗效果。方法对神经外科于2009—2012年所收治的36例老年颅脑损伤后治疗过程中并发低钠血症患者的病因、发病机制、临床表现、治疗过程等临床资料进行回顾性分析。结果在36名患者中,其中按低钠程度分类有轻度低钠血症16例,中度低钠血症15例,重度低钠血症5例;按病因分类有营养性低钠血症22例,抗利尿激素分泌异常综合征（SIADH）7例,脑性盐耗综合征（CSWS）5例,中枢性尿崩2例;根据不同病因给予相应治疗方案治疗后,其中30例患者血钠于1～2周内逐渐恢复正常,3例患者低血钠经纠正后又反复出现低钠血症持续约一个半月才恢复,另3例患者低钠血症纠正但死于原发脑损伤过重或其他并发症。结论低钠血症是老年颅脑损伤后患者的常见并发症,是脑外伤后加重脑水肿和神经功能损害的重要原因,在对老年颅脑损伤患者的治疗过程中应密切监测血钠浓度,及时发现低钠血症并鉴别其类型,同时根据低钠血症的发生机制及类型,采取不同的针对性的治疗方法,并且积极治疗控制原发病,均能及时纠正低钠血症,显著改善患者的预后。

Treatment experience of the hyponatremia in elderly patients after craniocerebral injury

Objective By summing up the hyponatremia elderly patients after craniocerebral injury our department admitted recently,to investigate the cause,processing method and therapeutic effect of the hyponatremia elderly patients after craniocerebral injury. Methods The clinical data including the causes,pathogenesis,clinical manifestation,therapeutic process of the 36 hyponatremia elderly patients after craniocerebral injury who hospitalized in our neurosurgery from 2009 to 2012 were reviewed and analyzed. Results In these patients,16 patients suffered from slight hyponatremia when the other 15 patients complicated moderate hyponatremia and 5 serious;according to the cause,22 patients suffered from nutritional hyponatremia,7 SIADH,5 CSWS and 2 diabetes insipidus happended. After giving corresponding treatment according to the different causes,30 patients with hyponatremia returned to normal gradually in 1- 2 weeks,3 patients repeated low serum sodium cured in 6 weeks than the other 3 patients died from serious original craniocerebral injury or complications. Conclusion Hyponatremia was common complication in elderly patients after craniocerebral injury,which was the important reason of aggravating encephaledema and neurologic damage after craniocerebral injury. Between the therapeutic process of the hyponatremia elderly patients after craniocerebral injury,we must monitor the sodium concentration closely,find and distinguish the pathogenesis and type of hyponatremia,then take different targeted therapeutic method,treat and control the primary disease actively at the same time,in this way we can correct the hyponatremia timely,and significantly improve the prognosis of patients.