外伤后脑性盐耗综合征的诊断和治疗

目的探讨颅脑伤后脑性盐耗综合征 ( CSWS)的临床特点及治疗方法。方法 13例颅脑损伤患者 ,每日定时检测血钠及观察尿量变化并根据其变化结果调整治疗方案。结果患者伤后第 4～ 7天血钠平均为 10 7mmol/L,尿钠平均为 6 2 mmol/L ;血渗透压平均 2 0 5m Osm/kg,尿渗透压平均 40 9m Osm/kg,尿比重平均 1.0 2 5。其中 5例予以限水 ,出现低血钠伴有中心静脉压下降、意识障碍加重。补给充足水、盐后 ,伤后第 14～ 2 1天 ,血钠平均回升至 137mmol/L,基本恢复正常。 2周恢复 8例 ,4周恢复 3例 ,半年内恢复 1例 ,伤后7天死亡 1例。结论颅脑伤特别是下丘脑、三脑室旁脑挫裂伤易出现脑性盐耗综合征 ,应区别于抗利尿激素分泌不当综合征 ;CSWS者应补给充足水、盐 ;根据水、钠检测水平治疗

Cerebral salt wasting syndrome after cerebral trauma

Objective To explore the clinical features and treatment for the cerebral salt wasting syndrome(CSWS) after cerebral trauma.Methods The blood sodium and urine volume in 13 cases with cerebral trauma were observed regularly everyday, so to adjust the treatment protocol.Results 4-7 days after cerebral trauma, blood sodium, urine natrium, blood osmotic pressure, urine osmotic pressure and urine specific gravity averaged 107mmol/L, 62 mmol/L, 205 mOsm/L, 409 mOsm/L and 1.025, respectively. Among them, 5 cases were treated with limited water, who would be given enough water and salt if central venous pressure would decline when hyponatrimia appeared. 14-21 days after trauma, the blood natrium would rise to 137 mmol/L, which generally recovered to normal. 8 cases recovered within 2 weeks, 3 within 4 weeks, 1 in half a year and 1 died on the 7 days after trauma.Conclusion CSWS is apt to appear after cerebral injury, especially contusion and laceration of hypothalamus and the region near to the 3rd ventricle which should be differentiated from syndrome of inappropriate antidiuretic hormone secretion(SIADH). CSWS should be treated with enough water and salt, according to the level of water and sodium.