CAJ | 학술논문

目的探讨如何正确认识、早期及时诊断和准确治疗尿崩症合并脑性盐耗综合征,以提高救治成功率.方法回顾性分析6例尿崩症合并脑性盐耗综合征的临床特点:尿量特别异常增多、高脑利钠肽水平和显著尿钠排泄增加是其最显著特征；尿比重、血钠水平和血浆渗透压可以正常；尿量增多单纯加压素疗效不佳,而加用醋酸可的松治疗有效.结果 6例患者及时正确诊断为尿崩症合并脑性盐耗综合征,但其中1例患者因为血钠上升过快出现脑桥脱髓鞘病变,最终植物状态；1例患者因脑疝、多脏衰而死亡；其余4例患者治愈出院.结论根据尿崩症合并脑性盐耗综合征的临床特点本文提出其参考诊断标准,及时诊断和正确治疗是成功救治的关键.
목적 탐토여하정학인식、조기급시진단화준학치료뇨붕증합병뇌성염모종합정,이제고구치성공솔.방법 회고성분석6례뇨붕증합병뇌성염모종합정적림상특점:뇨량특별이상증다、고뇌리납태수평화현저뇨납배설증가시기최현저특정；뇨비중、혈납수평화혈장삼투압가이정상；뇨량증다단순가압소료효불가,이가용작산가적송치료유효.결과 6례환자급시정학진단위뇨붕증합병뇌성염모종합정,단기중1례환자인위혈납상승과쾌출현뇌교탈수초병변,최종식물상태；1례환자인뇌산、다장쇠이사망；기여4례환자치유출원.결론 근거뇨붕증합병뇌성염모종합정적림상특점본문제출기삼고진단표준,급시진단화정학치료시성공구치적관건.
Objective To discuss the diagnosis coexistence of central diabetes insipidus and cerebral salt wasting syndrome promptly and treat properly.Method Six patients who suffered central diabetes insipidus combined cerebral salt wasting syndrome were analyzed retrospectively.Its characteristics was massive polyuria which can not be controlled by vasopressin alone,but can be controlled by both vasopresin and cortisone acetate.Sodium chloride saline were mainly used to make up for the loss of water and salt.Other charactefistcs were including low CVP,high Pro - BNP,high 24 h urine sodium evacuation with normal serum sodium level,higher osmolarity in urine than in serum which was at normal level,and usually normal urine specific gravity.Results One died and one became vegetative state,other four patients discharged with Glasgow Coma Scale 15.Conclusions Monitoring of water and sodium metabolism systemically were critical to diagnose the concurrent DI and CSW.Slow sodium chloride saline supplement,cortisone acetate and desmopressin were the keys to deal with concurrent DI and CSW.With exact diagnosis and treatment promptly,favourable outcome can be achieved.