中-重型颅脑损伤患者血钠异常与损伤类型的相关性研究

目的：探讨中-重型颅脑损伤患者的血钠异常与颅脑损伤类型之间的相关性。方法上海健康医学院附属周浦医院神经外科2014年3~12月收治中、重型颅脑损伤97例，根据CT表现，诊断为硬膜外血肿19例、硬膜下血肿28例、蛛网膜下腔出血27例、脑内血肿32例及弥漫性轴索损伤8例。所有患者在急诊室及入院后定期测量血钠，血钠<130 mmol/L或>145 mmol/L者为血钠异常。通过配对χ2检验，比较各类型颅脑损伤与血钠异常之间的相关性。结果97例患者中41例(42.3%)出现血钠异常，其中18例(18.6%)出现高钠血症，23例(23.7%)出现低钠血症；在各类型颅脑损伤的血钠异常中急性硬膜外血肿6例(26.3%)，急性硬膜下血肿11例(39.3%)，脑内血肿12例(44.4%)，蛛网膜下腔出血14例(43.8%)，弥漫性轴索损伤5例(62.5%)，颅脑损伤的类型与血钠异常发生率之间比较差异无统计学意义(P>0.05)。结论血钠异常在中、重型颅脑损伤中发生率较高，但与颅脑损伤类型无相关性。在各类型中、重型颅脑损伤治疗过程中，应当早期和全程检测血钠水平，并及时纠正，有利于提高患者预后。

Correlation between sodium disorders and different injury types in moderate and severe traumatic brain injuries

Objective To determine the incidence of sodium disorders and its association with different injury types in patients with moderate and severe traumatic brain injuries (TBI). Methods This study was conducted in 97 pa-tients diagnosed as moderate and severe TBI admitted in the Department of Neurosurgery, Zhoupu Hospital Affiliated to Shanghai University of Medicine and Health Sciences, including 19 cases of epidural hematoma, 28 cases of subdural he-matoma, 27 cases of subaracnoid hemorrhage, 32 cases of intracerebral hematoma and 8 cases of diffuse axonal injury. Serum sodium was detected in Emergency Department and at admission, and sodium disorders were considered as at least one serum sodium detection was<130 mmol/L or>145 mmol/L. Correlation between sodium disorders and differ-ent injury types were analyzed through chi-square test. Results Among the 97 patients, 41 showed sodium disorders, with the incidence of 42.3%, including 18 patients (18.6%) of hypernatremia and 23 patients (23.7%) of hyponatremia. Sodium disorders was found in 6 patients with epidural hematoma (26.3%), 11 patients with subdural hematoma (39.3%), 12 patients with intracerebral hematoma (44.4%), 14 patients with subaracnoid hemorrhage (43.8%) and 5 pa-tients with diffuse axonal injury (62.5%). The incidences of sodium disorders showed no significant difference between different injury types (P>0.05). Conclusion The incidence of sodium disorders is high in moderate and severe TBI, but it has no correlation with injury types. We should pay attention to sodium level early and in the whole course in the treat-ment of TBI.