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目的:探讨重度颅脑损伤后中枢性低钠血症的诊治方法。方法:回顾性分析28例重度颅脑损伤后低钠血症患者的临床资料。结果:经治疗后血钠逐渐回升,尿钠逐渐下降,本组28例,2例死于原发性脑干损伤并多器官功能衰竭,2例放弃治疗,其余患者治疗3～15天血钠均恢复正常。结论:根据临床表现、实验室指标、尿量及中心静脉压监测可以对中枢性低钠血症进行病因诊断。一旦确诊,抗利尿激素分泌异常综合征患者治疗主要是严格限制水、盐,减少补液量,必要时酌情加用呋塞米、抑制抗利尿激素分泌的药物。脑性耗盐综合征患者应立即予以补充血容量并持续输入钠盐,使钠代谢维持于正态平衡,补钠补液,必要时加用盐皮质激治疗。
Objective: To investigate the diagnosis and treatment of central hyponatremia after severe craniocerebral injury. Methods: The clinical data of 28 patients with hyponatremia after severe craniocerebral injury were retrospectively analyzed. Results: After treatment, serum sodium gradually rose and urinary sodium gradually decreased. 28 patients in this group, 2 patients died of primary brain stem injury and multiple organ failure, 2 patients gave up treatment, and the remaining patients treated for 3 to 15 days of sodium All returned to normal. CONCLUSIONS: Etiologic diagnosis of central hyponatremia can be diagnosed based on clinical manifestations, laboratory tests, urine output, and central venous pressure monitoring. Once diagnosed, patients with anti-diuretic hormone secretion syndrome treatment is strictly limited water, salt, reduce fluid volume, if necessary, add furosemide, inhibition of anti-diuretic hormone secretion of drugs. Patients with brain salt-consuming syndrome should immediately be added to the blood volume and continue to enter the sodium salt, sodium metabolism to maintain normal balance, sodium replacement fluid, if necessary, plus salt cortical excitement therapy.