颅脑外伤术后脑耗盐综合征的治疗体会
张伟;孙艳霞;周晓丽;
摘要(Abstract):
目的:探讨颅脑外伤术后脑耗盐综合征的临床产生原因、特点、预防方法和治疗经验。方法:回顾性分析我院收治的收治的71例颅脑外伤术后出现脑耗盐综合征(Cerebral salt wasting syndrome,CSWS)患者的实验室检查指标、临床表现及预后,观察24 h尿量变化及每日钠盐的补充情况,并根据具体病情进行治疗。结果:颅脑外伤术后低钠血症71例患者中,术后110d出现低钠血症,经过治疗,64例血钠恢复正常,4例死亡,3例放弃治疗出院。结论:颅脑外伤术后患者易出现CSWS,术后除积极治疗原发病外,还应保持正常循环血容量,尽早补充含盐液体和食物,可以减少CSWS的发生。一旦出现CSWS应根据低钠的情况逐步平稳静脉补充高张盐水、补充充足水分及应用口服补液盐,食物中亦适量增加盐的含量,并适量应用糖皮质激素治疗。
关键词(KeyWords): 颅脑外伤术后;低钠血症;脑耗盐综合征
基金项目(Foundation):
作者(Authors): 张伟;孙艳霞;周晓丽;
DOI: 10.13799/j.cnki.mdjyxyxb.2014.03.044
参考文献(References):
- 1 涂通今.急症神经外科学.北京:人民军医出版社,1995:160-162.
- 2 Cerda Esteve M,Cuadrado Godia E,Chillaron J J,et al.Cerebral salt wasting syndrome:review[J].Eur J Intern Med,2008,19(4):249-254.
- 3 Barnett R.Nathan。Cerebral Correlates of Hyponatremia Neurocrit.Care 2007;06:72-78
- 4 Massieu L,Montiel T,Robles G,Quesada O.Brain amino acids during hyponatremia in vivo:Clinical observations and experimental studies.Neurochem Res 2004;29:73-81.
- 5 Palmer BF,Gates JR,Lader M.Causes and management of hyponatremia.Ann Pharmacother 2003;37:1694-1702.
- 6 Martin RJ.Central pontine and extrapontine myelinolysis:the osmotic demyelination syndromes.J Neurol Neurosurg Psychiatry 2004;75(suppl III):iii22-iii28.
- 7 Gullans SR,Verbalis JG.Control of brain volume during hyperosmolar and hypoosmolar conditions.Annu Rev Med 1993;44:289-301.
- 8 MARTIN RJ.Central pontine and extrapontine myelinolysis:the osmotic demyelination syndromes[J].J Neurol Neurosurg Psychiatry,2004,75(Suppl 3):22-28.
- 9 董祥宁,蒋宗惠,秦涛.晚期肿瘤合并低钠低钾的诊疗[J].中华全科医学,2011,9(2):201-202.