课件：老年人低钠血症的诊治.pptVIP

急性症状性低钠血症是非常危重的临床状态。 低钠，水平衡驱使水透过脑细胞膜致细胞肿胀。由于颅骨的限制性，急性低钠可致严重脑水肿，脑疝，和心肺骤停。 随时间延长，脑内可发生适应性变化。最初1-3小时，细胞外液移动至脑脊液，然后进入循环。 缓慢适应过程中，脑细胞逐出钾离子和有机溶质，以减少细胞内渗透浓度及脑水肿。 持续低钠超过48小时，其它有机渗透分子（磷酸肌酸、肌醇、和氨基酸如谷氨酸盐）排出，致使脑细胞失水，脑容量恢复至接近正常，但这是以脑细胞丢失钾和其他有机渗透分子为代价。 * * Of 106 randomized subjects (lixivaptan,?n=54; placebo,?n=52), 101 received treatment, and 73 completed both the treatment period and follow-up periods of the study (Figure 1). In both treatment arms, the most common reason for discontinuation was withdrawal of consent. Baseline characteristics of subjects who received the study drug have been summarized in?Table 1. Most subjects were white and from North America or Western Europe. More than half of the subjects were? 65 years of age. Although baseline characteristics were generally well balanced between groups, significantly fewer subjects in the lixivaptan group were on fluid restriction at baseline compared with those in the placebo group (20 (37.0%) vs. 34 (65.4%) subjects, respectively;?P=0.004). Numerous symptoms of hyponatremia were apparent at baseline, most commonly fatigue and slowing of mental faculties (Figure 2). The underlying cause of SIADH was not investigated prospectively in the study. At baseline, eight patients (8.0%) had lung cancer, two (2.0%) had human immunodeficiency virus infection, and 33 (33%) were receiving drugs known to induce hyponatremia, including carbamazepine (7.0%), cyclophosphamide (1.0%), phenothiazines (2.0%), selective serotonin reuptake inhibitors (10.0%), thiazides (6.0%), and monoamine oxidase inhibitors (7.0%). Of 106 randomized subjects (lixivaptan,?n=54; placebo,?n=52), 101 received treatment, and 73 completed both the treatment period and follow-up periods of the study (Figure 1). In both treatment arms, the most common reason for discontinuation was withdrawal of consent. Baseline characteristics of subjects who received the study drug have been summarized in?Table 1. Most subjects were white and from North America or Western Eu