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不同程度及类型颅脑损伤中枢性低钠血症患者临床特点研究 被引量:13

Clinical Characteristics of Central Hyponatremia in Craniocerebral Injury of Different Degrees and Types
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摘要 目的分析颅脑损伤中枢性低钠血症的临床特点,以提高该病诊治水平。方法选取我院2014年1月—2016年12月收治的颅脑损伤中枢性低钠血症300例,根据格拉斯哥昏迷评分分为重度颅脑损伤组(3~8分)142例,中度颅脑损伤组(9~11分)93例,轻度颅脑损伤组(12~15分)65例;再根据发生类型分为抗利尿激素分泌不当综合征(syndrome of inappropriate secrtion of antidiuretic hormone, SIADH)组111例和脑性耗盐综合征(cerebral salt wasting syndrome, CSWS)组189例。观察不同程度、类型颅脑损伤中枢性低钠血症患者发病情况及纠正低钠血症前相关临床指标[中心静脉压(CVP)、红细胞压积(HCT)、血红蛋白(Hb)、血渗透压、心利钠肽(ANP)、抗利尿激素(ADH)]水平。结果随颅脑损伤程度的加重,中枢性低钠血症发病时间逐渐缩短,症状持续时间逐渐延长,差异均有统计学意义( P <0.05)。随颅脑损伤程度的加重,CVP、ADH逐渐升高,ANP逐渐降低,差异均有统计学意义( P <0.05)。SIADH组发病时间及症状持续时间均短于CSWS组( P <0.05)。SIADH组CVP、HCT、Hb、ADH水平高于CSWS组,ANP水平低于CSWS组,差异均有统计学意义( P <0.05)。结论颅脑损伤中枢性低钠血症与颅脑损伤程度密切相关,随颅脑损伤程度的加重,CVP、ADH逐渐升高,ANP逐渐降低;SIADH发病时间较早,症状持续时间较短,CVP、血容量、ANP和ADH对SIADH与CSWS鉴别有提示作用。 ObjectiveTo analyze the clinical characteristics of central hyponatremia after craniocerebral injury in order to improve clinical diagnosis and treatment.MethodsA total of 300 patients with central hyponatremia after craniocerebral injury admitted to Qinhuangdao Military Industrial Hospital from January 2014 to December 2016 were selected.According to Glasgow coma score (GCS), they were divided into severe craniocerebral injury group (3-8 points, n =142), moderate craniocerebral injury group (9-11 points, n =93) and mild craniocerebral injury group (12 points, n =65).According to the type of disease occurrence, they were divided into syndrome of inappropriate secretion of antidiuretic hormone (SIADH) group ( n =111) and cerebral salt wasting syndrome (CSWS) group ( n =189).The incidence of central hyponatremia in different degrees and types of craniocerebral injury group and the levels of related clinical indicators [central venous pressure (CVP), hematocrit (HCT), hemoglobin (Hb), blood osmotic pressure, uatrial natriuretic peptide (ANP), and antidiuretic hormone (ADH)] were compared.ResultsWith the aggravation of craniocerebral injury, the onset interval was gradually shortened and the duration of symptoms was gradually lengthened ( P <0.05).With the aggravation of craniocerebral injury, CVP and ADH were increased and ANP was decreased gradually ( P <0.05).The interval of onset and duration of symptoms in SIADH group were shorter than those in CSWS group ( P <0.05).The levels of CVP, HCT, Hb and ADH in SIADH group were higher than those in CSWS group, and the levels of ANP in SIADH group were lower than those in CSWS group ( P <0.05).ConclusionThe occurrence of central hyponatremia after craniocerebral injury is closely related to the degree of craniocerebral injury.With the aggravation of craniocerebral injury, CVP and ADH are gradually increased and ANP is gradually decreased.SIADH occurs earlier and lasts for a shorter period of time.CVP, blood volume, ANP and ADH can be used to differentiate between SIADH a
作者 陈志永 王振兴 刘爽 CHEN Zhi-yong;WANG Zhen-xing;LIU Shuang(Department of Neurosurgery,the Military Industrial Hospital of Qinhuangdao,Qinhuangdao,Hebei 066400,China;Department of Rehabilitation Medicine,the Military Industrial Hospital of Qinhuangdao,Qinhuangdao,Hebei 066400,China)
出处 《临床误诊误治》 2019年第10期80-84,共5页 Clinical Misdiagnosis & Mistherapy
基金 秦皇岛市科学技术研究与发展计划项目(201703A128)
关键词 颅脑损伤 中枢性低钠血症 临床特点 治疗与诊断 Craniocerebral trauma Central hyponatremia Clinical characteristics Treatment and diagnosis
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