脑性盐耗综合征54例临床分析

目的探讨颅脑损伤、脑血管病及颅内占位性病变切除术后并发脑性盐耗综合征的原因、诊断及治疗方法，以提高颅脑疾病的综合治疗水平．方法回顾性分析54例颅脑损伤、脑血管病及颅内占位性病变切除术后并发脑性盐耗综合征患者的临床资料．结果全部病例均符合CSWS诊断金标准，患者于术后4—10d血清钠均低于130mmol／L，24h尿钠均大于80mmol／L，血浆渗透压小于270mmol／L．经治疗，48例患者恢复正常，2例患者入院后病情危重死亡，1例放弃治疗，死于低钠血症，1例死于术后出血性脑梗死，2例为长期植物生存状态．结论脑性盐耗综合征诊断标准是低血钠、高尿钠、低血容量，中重度颅脑外伤术后和鞍区、下丘脑病变患者手术后常并发此症，应该及时给予患者补钠、补液治疗，绝大多数预后良好．

Clinical Analysis of 54 Cases with CSWS

Objective To explore the etiology, diagnosis and treatment in Cerebral Salt Wasting Syndrome （CSWS） complicated with craniocerebral injury, cerebrovascular disease （CVD） and post-ectomy of intracranial spaceoccupying lesion, to improve the overall treatment level of cranial diseases. Method The clinic data of 54 cases with CSWS complicated with craniocerebral injury, CVD and post-ectomy of intracranial spaceoccupying lesion were retrospectively analyzed. Results All cases had confirmed diagnosis of CSWS by the golden criteria, serum natrium is lower than 130 mmol/L after 4 - 10 days post-operation, urine natrium is higher than 80 mmol/L after 24 h, plasma osmotic pressure is lower than 270 mmol/L. 48 cases recovered after treatment, 2 cases died of exacerbation, 1 case gave up treatment and died of hyponatrium, 1 case died of hemorrhagic cerebral infarction, 2 cases turned to vegetative state. Conclusion The moderate and severe traumatic cranial trauma and saddle, hypothalamic lesions are common. Hyponatremia, high urinary natrium and hypovolemia are the diagnostic criteria of CSWS. Sodium and fluid supplement treatment are essential for eusemia in time.