神经外科低钠血症的诊断及治疗.docVIP

精品论文 参考文献 神经外科低钠血症的诊断及治疗 杨勇灵 朱婕 杨彦妮 沈健（贵州省黔东南州人民医院 贵州凯里 556000） 　　【摘要】目的 探讨神经外科患者并发低钠血症的原因、分类、诊断和治疗。方法 收集6645例神经外科患者的临床资料，649例适合入选病例的标准，均在神经外科疾病基础上并发低钠血症，同时排除肝脏、肾脏、心脏、甲状腺等其他器质性疾病所致的低钠血症。分析649例低钠血症产生的原因，分类诊断及治疗方法。结果 低钠血症发生率9.8%，其中，单纯性低钠血症550例，84.7%；脑性盐耗综合征（CSWS）51例，7.9%；尿崩症（DI）35例，5.4%；抗利尿激素不适当分泌综合征（SIADH）13例，2.0%。引起低钠血症神经外科疾病：血管瘤破裂致蛛网膜下腔出血121例，19.9%；颅内感染13例，17.5%；颅脑外伤296例，9.1%；高血压脑出血183例，8.4%；颅内肿瘤36例，6.7%。结论 低钠血症是神经外科常见的并发症，发生的原因是：利尿过度或摄入不足引起的单纯性低钠、CSWS、DI、SIADH是引起低钠的原因。由于临床表现相似，加上基础上疾病的掩盖，临床上容易混淆，应仔细分析产生低钠的原因，做到早发现，针对不同的病因进行治疗。 　　【关键词】低钠血症 脑性盐耗综合征 抗利尿激素分泌不当综合征 尿崩症 　　【中图分类号】R55 【文献标识码】A 【文章编号】2095-1752（2013）31-0131-02 　　Diagnosis and treatment of management of hyponatremia in neurosurgical patients ,yang yongling ,the people hospital of southeast autonomous prefecture Guizhou,province 556000 　　【Abstract 】Objective: Discussing the cause, classification, diagnosis and treatment of the neurosurgery patients complicated with hyponatremia. Method: Collecting the clinical data of 6645 patients with neurosurgery in which 649 patients are suitable for the study standards: they all suffer from hypokalemia on the basis of neurosurgical diseases and to rule out the hyponatremia which results from liver disease, kidney disease, heart disease, thyroid disease or other organic diseases. To do analysis of the causes, classifications, diagnosis and treatments of the 649 patients with hyponatremia Results: The incidence of hyponatremia is 9.8%, and the simple hyponatremia holds 550 cases and it accounts for 85% of all the 649 cases; there are 51 cases of Cerebral Salt Wasting Syndrome(CSWS) accounting for 7.9%; 35 cases of Diabetes Insipidus(DI) accounting for 5.4%; 13 cases of Syndrome of Inappropriate Antidiuretic Hormone(SIADH) accounting for 2.0%. About causing the neurosurgical disease complicated with hyponatremia: 121 cases of Subarachnoid Hemorrhage(SAH) caused by rupture of hemangioma accounting for 19.9%