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目的探讨重型颅脑损伤继发高钠血症的病因学机制及临床治疗策略。方法回顾169例重型颅脑损伤继发高钠血症病例的临床和预后资料并进行统计学分析。结果重型颅脑损伤继发高钠血症发生于60例病例,与24小时出量、入院GCS评分关系密切。重型颅脑损伤继发高钠血症病例病死率明显增高。36例经连续血液净化治疗好转,其中无病例死亡。结论在规范治疗条件下,下丘脑损害相关水电解质失衡是重型颅脑损伤继发高钠血症的主要原因。积极治疗原发病、密切监测血钠浓度、及时调整水电解质平衡并加强连续血液净化疗法应用是治疗重型颅脑损伤继发高钠血症的关键。
Objective To investigate the etiological mechanism and clinical treatment strategy of secondary hypernatremia in severe craniocerebral injury. Methods The clinical and prognostic data of 169 cases of severe head injury secondary to hypernatremia were retrospectively analyzed and statistically analyzed. Results Secondary hypernatremia occurred in 60 cases of severe craniocerebral injury, which was closely related to the GCS score of 24 hours and admission. Severe craniocerebral injury secondary to hypernatremia cases mortality was significantly higher. 36 cases of continuous blood purification treatment improved, of which no case of death. Conclusions Under the standard treatment conditions, imbalance of water and electrolyte related to hypothalamic damage is the main reason of secondary hypernatremia in severe craniocerebral injury. Active treatment of the primary disease, close monitoring of serum sodium concentration, timely adjustment of water and electrolyte balance and strengthen the application of continuous blood purification therapy is the key to the treatment of severe craniocerebral injury secondary to hypernatremia.