重度颅脑损伤合并脑性耗盐综合征、抗利尿激素分泌异常综合征的早期临床诊断意义及预后分析

摘要

目的 探讨重度颅脑损伤合并脑性耗盐综合征、抗利尿激素分泌异常综合征早期诊断的临床意义及预后分析.方法 将47例重度颅脑损伤患者按照脑性耗盐(CSWS)、抗利尿激素分泌异常综合征(SIADH)的诊断标准分为CSWS组和SIADH组,比较两组实验室检查并采用Cox风险比例分析预后影响因素.结果 ①CSWS组在治疗后心钠肽(ANP)、脑钠肽(BNP)降低,与治疗时比较有显著性差异(P<0.05或P<0.01);②治疗结束后,CSWS、SIADH患者格拉斯哥预后(GCS)评分3分以下、5分患者明显低于4分组(P<0.05);④Cox风险比例模型分析显示,颅底骨折、脑血肿、血渗透压、血钠、皮质醇(HC)、醛固酮(AL)为CSWS、SIADH患者预后危险因素,CSWS与ANP、BNP具有明显的相关性.结论 重度颅脑损伤CSWS、SIADH可以通过CVP、ADH以及ANP、BNP变化进行鉴别,同时对预后有重要影响.%Objective To investigate the significance of early diagnosis and prognosis for severe traumatic cerebral injury combined with cerebral salt wasting and abnormal secretion of antidiuretic hormone syndrome.Method 47 cases of severe traumatic cerebral injury were divided into syndrome of inappropriate antidiuretic hormone secretion (SIADH) group and cerebral salt wasting (CSWS) group according to CSWS, SIADH diagnostic criteria. Laboratory tests were compared between groups. Prognosis and hazards factors were analyzed by Cox proportional analysis. Results ① Atrial natriuretic peptide (ANP), brain Natriuretic Peptide (BNP) of CSWS group reduced after treatment, which had a significant difference compared to the treatment (P<0.05 orP<0.01).②After treatment, GCS score<3 and 5 point in CSWS, SIADH patients were significantly lower than four point group (P<0.05).④Cox proportional hazards model analysis showed that skull fracture, cerebral hematoma, blood osmolality, sodium, hydrocortisone (HC), aldosterone (AL) were hazard factors for CSWS, SIADH. ANP, BNP had obvious relevance with CSWS.Conclusion CSWS, SIADH can be identified by CVP, ADH, ANP and BNP after severe traumatic cerebral injury, which have a major impact on the prognosis.