CAJ | 학술논문

目的：探讨重度颅脑损伤并发顽固性高钠血症的病因及使用去氨加压素的疗效。方法回顾分析40例重度颅脑损伤并发顽固性高钠血症患者的病例资料。患者均为使用常规处理方法效果欠佳,予加用微量泵静脉泵入去氨加压素治疗。结果顽固性高钠血症多发生在重度颅脑损伤后5d内,平均(1.6±1.3)d,均有中枢性尿崩表现,常规降血钠处理方法无效情况下加用去氨加压素处理后所有患者血钠较前明显下降或逐渐恢复正常,治疗14 d死亡率37.5%,28 d死亡率67.5%。结论在重度颅脑损伤后5 d[平均(1.6±1.3)d]内发生顽固性高钠血症的主要原因可能为中枢性尿崩,常规降血钠治疗加用去氨加压素能有效地降低血钠,但总体死亡率仍然较高。
목적：탐토중도로뇌손상병발완고성고납혈증적병인급사용거안가압소적료효。방법회고분석40례중도로뇌손상병발완고성고납혈증환자적병례자료。환자균위사용상규처리방법효과흠가,여가용미량빙정맥빙입거안가압소치료。결과완고성고납혈증다발생재중도로뇌손상후5d내,평균(1.6±1.3)d,균유중추성뇨붕표현,상규강혈납처리방법무효정황하가용거안가압소처리후소유환자혈납교전명현하강혹축점회복정상,치료14 d사망솔37.5%,28 d사망솔67.5%。결론재중도로뇌손상후5 d[평균(1.6±1.3)d]내발생완고성고납혈증적주요원인가능위중추성뇨붕,상규강혈납치료가용거안가압소능유효지강저혈납,단총체사망솔잉연교고。
Objective To investigate the pathogenesis of severe craniocerebral injury complicated with intractable hypernatremia, and the curative effect of desmopressin. Methods A retrospective analysis was made on clinical data of 40 severe craniocerebral injury complicated with intractable hypernatremia patients. They all received small dose of desmopressin by intravenous pump for treatment, due to their poor effect after receiving conventional method. Results Intractable hypernatremia mainly occurred within 5 d of severe craniocerebral injury, the average time was (1.6±1.3)d. All patients had central urine collapse, and conventional serum sodium decline method was ineffective for them. Desmopressin was applied to provide obvious decline or gradual recovery. Mortality rate in 14 d was 37.5%, and that in 28 d was 67.5%. Conclusion Central urine collapse may be the main factor of intractable hypernatremia within 5 d[average (1.6±1.3)d]of severe craniocerebral injury. Combination of conventional serum sodium decline method and additional desmopressin can effective reduce serum sodium level, while the total mortality rate is still high.