摘要
目的探研脑创伤患者合并合并脑性盐耗综合症或抗利尿激素分泌不当综合征的鉴别诊断。方法选取2016-2018本院急诊外科收治的因脑外伤所导致的有症状和体征的低血钠的患者共93例。脑外伤后无低钠血症诊断的患者50例。分为三组:脑性盐耗综合症组,55名患者入院后被诊断为脑性盐耗综合症,患者血钠均低于130mmol/L但高100mmol/L。抗利尿激素异常分泌综合症,共38例患者诊断为抗利尿激素异常分泌综合症,患者入院后均出现低钠血症。对照组,共50例脑外伤后无低钠血症诊断。所有患者均采静脉血测定血浆钠、钾、肌酐、肌酐清除率,尿酸和皮质醇。收集24 h尿液,测量钠、钾和渗透压,记录24 h尿量作为诊断CSWS与SIADH的依据。结果CSWS患者尿钠为387±355 mmol/24 h,尿量为2830±876/24 h,均明显高于对照组(P<0.001)。SIADH组尿钠排泄量为49±27 mmol/24 h,尿量为733±232/24 h,均明显低于CSWS组(P<0.01)。结论脑外伤患者合并脑性盐耗综合症的的诊断标准有脑外伤病史,低血钠,及尿钠和24 h尿量的增多。其中尿钠和24 h尿量较合并抗利尿激素异常分泌综合症患者明显增高,可作为两种疾病重要的鉴别诊断标准。
Objective To investigate the differential diagnosis of cerebral salt wasting syndrome(CSWS)or inappropriate antidiuretic hormone secretion syndrome(SIADH)in patients with brain trauma.Methods A total of 93 patients with hyponatremia due to brain trauma were selected in our hospital from 2016 to 2018.There were 50 patients without hyponatremia after brain injury.They were divided into three groups:the cerebral salt consumption syndrome group,55 patients were diagnosed with cerebral salt consumption syndrome after admission,and their blood sodium was lower than 130 mmol/L but higher than 100 mmol/L.38 patients were diagnosed as syndrome of abnormal secretion of antidiuretic hormone.All patients had hyponatremia after admission.The control group,a total of 50 cases of brain injury after hyponatremia diagnosis.Plasma sodium,potassium,creatinine,creatinine clearance rate,uric acid and cortisol were measured in all patients.The 24-hour urine was collected,sodium,potassium and osmotic pressure were measured.The 24-hour urine volume was recorded as the basis for the diagnosis of CSWS and SIADH.Results The urine sodium of CSWS patients was 387±355 mmol/24 h and the urine volume was 2830±876/24 h,which were significantly higher than that of the control group(P<0.001).The urinary sodium excretion in SIADH group was 49±27 mmol/24 h and 733±232/24 h,which were significantly lower than that of the CSWS group(P<0.01).Conclusions The diagnostic criteria of brain injury patients with cerebral salt wasting syndrome are history of brain injury,hyponatremia,increase of urinary sodium and 24-hour urine volume.Urinary sodium and 24-hour urine volume were significantly higher than that of patients with abnormal antidiuretic hormone secretion syndrome,which can be used as an important differential diagnostic criteria for the two diseases.
作者
赵浩东
吴雪生
张刘兆
陈卫东
程炯炯
胡志旭
ZHAO Haodong;WU Xuesheng;ZHANG Liuzhao;CHENG Weidong;CHEN Jiongjiong;HU Zhixu(Department of Emergency Surgery,The First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)
出处
《新疆医学》
2020年第10期1049-1051,1071,共4页
Xinjiang Medical Journal
关键词
脑性盐耗综合症
抗利尿激素异常分泌综合症
低钠血症
尿钠
Cerebral Salt Wasting Syndrome
Abnormal Antidiuretic Hormone Secretion Syndrome
Hyponatremia
Urinary Sodium
