外伤性颅内血肿清除术后并发抗利尿激素不适当分泌综合征5例报告

本文报告外伤性颅内血肿清除术后并发抗利尿激素不适当分泌综合征（ＳＩＡＤＨ）５例。分别于术后或术后颅内感染后１－１６天开始出现低血钠、低血渗。开始均按营养性低血钠补钠治疗，血钠均未回升至正常范围，逐监测尿钠尿渗其最高值分别为７８４ｍｍｏｌ／２４ｈ、３５２ｍＯｓｍ／Ｌ。同时他们的肾功能正常，无肾上腺皮质及甲状腺功能代下表现，故诊断为ＳＩＡＤＨ。即停用高渗盐水，限制液体水量，辅以双氢克尿塞、速尿、碳酸锂

Syndrome of inappropriate antidiuretic hormone after removal of traumatic intracranial hematoma A report of five cases

Five cases of syndrome of inappropriate antidiuretic hormone (SIADH) after removal of traumatic intracranial hematoma were teported. Hyponatremia and hypo-osmolality developed 1-16 days after the operation with or without subsequent infection.The lowest serum sodium concentration and osmolality were 107 mmol/L and 250 mOsm/L respectively.All the five cases were treated as nutritional hyponatremia at first,and 10% NaCl 50-100 ml was infused daily for 7-15 days without effect.Monitoring of the renal sodium excertion and urine osmolality revealed the highest value to be 784 mmol/24h and 352 mOsm/l respectively.At the same time,renal function was found to be normal and there was no evidence of adrenal insufficiency or hypothyroidism.Hypertonic salineinfusion was discontinued, and the patient was treated with limitation of water intake,dihydrochlorotbiazid 75mg/d and lithium carbonate 0.9g/d orally,and furosemide 40-80mg intravenously.7-10 days after such treatment,serum sodium and osmolality,urinary sodim exertion and urine osmolality were all normalized.The pathogenesis,diagnosis and differential diagnosis of SIADH were briefly discussed.