摘要
目的 探讨颅脑损伤后抗利尿激素异常分泌综合征 (SIADH )的诊断和治疗。方法 对我科 12例颅脑损伤后SIADH患者进行回顾性研究分析 ,临床表现即为一般性低钠血症表现 ,无特异性 ,多在常规检查时发现低钠血症 ,首先按真性失盐常规补钠治疗 ,补钠治疗 2～ 3d后血钠不回升或仍在下降 ,且补钠量与尿钠量相当 ,初步考虑为SIADH ,改为限水、钠治疗 ,脱水治疗以速尿 +白蛋白为首选。结果 本组 12例病人在限水钠治疗后 2 4h～ 48h血钠均有不同程度的回升 ,除 2例在治疗期间因死亡血钠未完全恢复正常外 ,8例病人在限水治疗 1周内血钠恢复正常 ,1例在 14d恢复正常 ,1例在伤后 3个月恢复正常。结论 SIADH在治疗前诊断非常困难 ,但是采取正确的策略可以得到有效治疗 ,本组病例均在治疗中验证了SIADH的诊断 ,我们称之为治疗性诊断。
Objective To study the diagnosis and treatment of the inappropriate antidiuretic hormone secretion(SIADH) syndrome after cerebral injury. Methods A retrospective analysis was conducted on 12 patients suffered from SIADH after cerebral injury. The clinical features were similar to common hyponatremia, no specific manifestation. Most of the hyponatremia were detected by routine examination. The first of all,sodium losing in these patients with hyponatremia was routine supplied according the amont of true salt losing.If natremia was not raised or still more descended 2～3 days after treatment, and amount of supplying salt was correspond to that of natriuresis, SIADH should be considered,using restricting water therapy,substituted for salt supplement.furosemide plus albumin were the first choice for dehydration therapy. Results 24～48h after restricting water and natrium, 12 patient's natremia level was back up in different degree. Except for 2 death whose natremia was not corrected completely, 8 patient's natremia was corrected completely in 1 week, 1 patient's in 14 days, and 1 in 3 months after injury. Conclusions Diagnosis of SIADH is very difficult before treatment, but effective treatment can be obtained if we adopt correcting strategy. In these patients, the diagnosis of SIADH was confirmed with the course of treatment,we call it as therapeutic diagnosis.
出处
《中国医师杂志》
CAS
2003年第2期192-193,共2页
Journal of Chinese Physician
