颅脑损伤后抗利尿激素分泌异常综合征

目的:探讨颅脑损伤后抗利尿激素分泌异常综合征(SIADH)的诊断与治疗。方法:回顾性分析近7年收治的11例颅脑损伤并发SIADH的临床特点。首先按真性失盐常规补钠治疗,2～3d后血钠不回升或继续降低,补钠量与失钠量相当,考虑为SIADH,改为限水限钠治疗。结果:11例颅脑损伤合并SIADH均具有以下临床特点:低钠血症、低血浆渗透压、尿渗透压与血浆渗透压之比>1。治愈10例,死亡1例。结论:颅脑损伤并发SIADH的发病机制与治疗措施不同于低钠血症,早期诊治能降低颅脑损伤患者的病残率和病死率。

Syndrome of Inappropriate Antidiuretic Hormone after Serious Cerebral Injury

Objective:To study the diagnosis and treatment of the syndrome of inappropriate antidiuretic hormone secretion(SIADH).Methods:Retrospective analysis of clinical features of 11patients of head trauma with syndrome of inappropriate secretion of antidiuretic hormone treated in the past 7 years.The fi rst of all,sodium losing in these patients with hyponatremia was routine supplied according the amout of ture salt losing.If natremia was not raised or still more descended 2-3 days after treatment,and amount of supplying salt was correspond to that of natriuresis,SIADH should be considered,using restricting water therapy,substituted for salt supplement.Results:11 patients of head trauma with syndrome of inappropriate secretion of antidiuretic hormone showed following clinical features:hyponatremia,low plasma osmotic pressure,the ratio of osmotic pressure of urine and plasma osmotic pressure >1.10 patients have been cured and 1 patients died.Conclusion:Pathogenesis and management of head trauma complicated with syndrome of inappropriate antidiuretic hormone secretion are different from that of hyponatremia.Early diaglosis and therapy reduce morbidity and mortality.