神经外科低钠血症的鉴别诊断和处理

目的探讨各型低钠血症的诊断和处理原则。方法回顾性分析562例低钠血症的临床资料,分出不同的类型给以不同的处理。结果562例中因利尿引起430例,补钠不足46例,尿崩症56例,抗利尿激素分泌不当综合征18例,恼性盐耗综合征11例,1例由肾小管损伤引起。结论因补钠不足或利尿引起的补钠即可,尿崩症以补充抗利尿激素为主,抗利尿激素分泌不当综合征应以限水为主,脑性盐耗综合征须采取综合治疗,肾小管损伤低钠血症会随着肾小管功能恢复而纠正。

Differential diagnosis and management of hyponatremia

Objective To discuss the diagnosis and management principles of various types of hyponatremia. Methods Clinical data of 562 cases of hyponatremia were analyzed retrospectively. All patients were treated corresponding to their differential diagnosis. Results 562 patients had hyponatremia due to diuretic in 430 cases, inadequate supplement of salt in 46 cases, diabetes insipidus in 56 cases, syndrome of inappropriate secretion of the antiduretic hormone (SIADH) in 18 cases, cerebral salt wasting syndrome (CSWS) in 11 cases, and damnification of renal tubule in 1 case. Conclusion Hyponatremia due to inadequate sodium or diuretic is subject to the supplementation of sodium in treatment, diabetes insipidus to the infusion of ADH and SIADH to containing of water intake. To cure the CSWS, comprehensive therapies must be taken into consideration. Hyponatremia due to damnification of renal tubule will get recovered as long as the function of renal tubule renew.