重型颅脑损伤合并低钠血症115例临床分析

目的探讨重型颅脑损伤合并低钠血症的诊治方法。方法对115例重型颅脑损伤合并低钠血症患者的临床诊治情况进行总结分析。结果营养性低钠血症70例,抗利尿激素异常分泌综合征14例,脑性耗盐综合征31例。营养性低钠血症和脑性耗盐综合征均给予补盐、补水治疗,抗利尿激素异常分泌综合征行限水治疗或限水补盐治疗。42例1周内纠正,29例2周内纠正,11例3周内纠正,5例4周内纠正,28例因病情较重死亡。结论临床上营养性低钠血症最常见,也最易纠正;抗利尿激素异常分泌综合征较少见,易误诊误治;营养性低钠血症和脑性耗盐综合征需要补液补盐治疗,而抗利尿激素异常分泌综合征则应该以限水治疗为原则。故要重视三者间的鉴别诊断,正确的诊断是治愈的关键。

Clinical analysis of 115 cases of severe cerebral injury with hyponatremia

Objective To study the clinical diagnosis and treatment of severe cerebral injury with hyponatremia.Methods The clinical diagnosis and treatment of 115 cases of severe cerebral injury with hyponatremia was summarized and analyzed.Results Among 115 cases,70 cases were nutritional hyponatremia.40 cases were syndrome of inappropriate secretion of antidiuretic hormone.31 cases were cerebral salt wasting syndrome.The nutritional hyponatremia and CSWS were treated by complementing salt and water,while the SIADH were treated by limiting the intake of water or combined with complementing salt.42 cases were cured within one week,29 cases within 2 weeks,11 cases within 3 weeks,and 5 cases within 4 weeks respectively.28 cases were died of severe pathogenic condition.Conclusion Nutritional hyponatremia is the most common clinical and could also be rectified easily.SIADH was rare relatively speaking and was more likely to be misdiagnosed and mistreated.The nutritional hyponatremia and CSWS required supplement of salt and water,but the treatment of SIDH should be follow the principle of limiting water.So,great importance should be attached to their differential diagnosis.Correct diagnosis was crucial for cure.