神经外科低钠血症的诊断及治疗

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1、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例低钠血症产牛的原因，分类诊断及治疗方法。结果低钠血症发牛率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%；

2、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，发牛的原因是：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，应仔细分析产牛低钠的原因，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

3、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)31-0131-02Diagnosisandtreatmentofmanagementofhyponatremiainneurosurgicalpatients,yangyongling,thepeoplehospitalofsoutheastautonomousprefectureGuizhou,provinee556000【Abstract】Objective:Discussingthecause,classifi

4、cation,diagnosisandtreatmentoftheneurosurgerypatientscomplicatedwithhyponatremia.Method:Collectingtheclinicaldataof6645patientswithneurosurgeryinwhich649patientsaresuitableforthestudystandards:theyallsufferfromhypokalemiaonthebasisofneurosurgicaldiseasesandtoruleo

5、utthehyponatremiawhichresultsfromliverdisease,kidneydisease,heartdisease,thyroiddiseaseorotherorganicdiseases.Todoanalysisofthecauses,class讦icat:ions,diagnosisandtreatmentsofthe649patientswithhyponatremiaResults:Theincideneeofhyponatremiais9.8%,andthesimplehyponat

6、remiaholds550casesanditaccountsfor85%ofallthe649cases;thereare51casesofCerebralSaltWastingSyndrome(CSWS)accountingfor7.9%;35casesofDiabetesInsipidus(DI)accountingfor5.4%;13casesofSyndromeofInappropriateAntidiureticHormone(SIADH)accountingfor2.0%.Aboutcausingtheneu

7、rosurgicaldiseasecomplicatedwithhyponatremia:121casesofSubarachnoidHemorrhage(SAH)causedbyruptureofhemangiomaaccountingfor19.9%;13casesofintracranialinfectionaccountingfor17.5%;296casesoferaniocerebraltraumaaccountingfor9.1%;183casesofHypertensiveCerebralHemorrhag

8、eaccounting8.4%;36casesofintracerebraltumoraccountingfor6.7%.Conclusion:Hyponatremiaisthecommoncomplicationofneurosurgery・Thecauseis:excessivediuresisor