外伤性蛛网膜下腔出血并发低钠血症28例诊治体会

探讨外伤性蛛网膜下腔出血(TSAH)并发低钠血症(HN)的发病机制、诊断和治疗方法。方法:对本院自2001年6月-2006年3月共收治诊断明确的28例TSAH并发(HN)的临床资料进行回顾性分析。结果:并发(HN)的28例患者全部根据检测结果及时补液补钠治疗,28例中1例死于肺部感染继发呼吸衰竭,1例死于应急激性溃疡出血,其余26例血钠均于4-13天内逐渐恢复正常。未发现因补液补钠治疗造成的相关并发症发生。结论神经系统损伤的治疗才是治疗低钠血症的根本所在。对TSAH并发HN患者监测电解质、血浆渗透压、中心静脉压,尿钠及尿量治疗具有重要意义,及时补液补钠可有效纠正。SIADH与CSWS引起的HN发病机制、治疗完全不同,必须加以鉴别。

Diagonsis and treatment of hyponatremia in Tranmatic subarachnoid hemorrhage

Objective:To investigate the pathogenetic mechanism,diagnosis and treatment of hyponatremia in Tranmatic subarachnoid hemorrhage.Methods:The 28 case HN patients with tranmatic subarachnoid hemorrhage,who were admitted to our hospital from 2001.6-2006.3,were retrospectively analyzed.Results:The 28 case patients of concurrence(HN) whole according to detect result and in time fluid replacement supply natrium to treat,in the 28 case one was died to pulmonary infection continue happened respiratory failure,the one was died meet an emergency ulcer bleed,for the rest 26 case blood natrium all revive normal by degrees inside 4-13 days.Not found because of fluid replacement supply natrium treatment to result in correlated complication happened.Conclusions:Treat of nervous system damage is fundamental about to treat hyponatremia.For tSAH complicating HN patients monitoring electrolytes、osmotic pressure of plasma、central venous pressure,UNa and urinary production treatment have important sense,in time fluid replacement supply natrium can correct utility.SIADH and CSWS were originated HN pathogenesy、treat completely different,this must identify.