颅脑创伤后水电解质紊乱的临床研究

发布时间：2018-04-02 18:55

本文选题：颅脑创伤　切入点：低钠血症　出处：《南方医科大学》2017年硕士论文

【摘要】：研究背景及目的神经外科的患者中,对于颅脑创伤的死亡原因的分析显示,约有62%的患者是死于颅脑创伤后的各种并发症,而在这当中由于颅脑创伤后内分泌功能障碍导致水电解质紊乱,进而内环境平衡遭到破坏,由此引起的死亡病例并不少见。其原因主要是由于颅脑创伤可能导致下丘脑-垂体这一联系系统的损伤,引起病理性的应激反应,进而导致水电解质紊乱或是多脏器功能受到损害或衰竭。颅脑创伤后患者的水电解质紊乱长期困扰着广大医疗工作者,包括低钠血症、高钠血症、及低钾血症等。水电解质紊乱不能得到及时纠正会导致患者预后水平的下降。但是临床医生对颅脑创伤后水电解质紊乱的认识不足,对其发生的规律不清楚,相关研究也较少。因此掌握颅脑创伤患者水电解质紊乱的特点及其影响因素具有重要的意义。研究方法回顾性分析我院神经外科118例颅脑创伤患者的详细临床资料,探讨水电解质紊乱发生的时间规律,分析不同类型、不同严重程度水电解质紊乱相关的影响因素,包括低钠血症、高钠血症、低钾血症和高钾血症,并分析其与预后的关系。结果不同严重程度的颅脑创伤患者,其低钠血症的严重程度无显著差异(p=0.639);不同严重程度的颅脑创伤患者,其高钠血症及低钾血症的发生与损伤的严重程度具有显著差异(p0.05);严重的低钠血症、高钠血症和低钾血症通常出现在伤后1-3天;不同受伤部位的颅脑创伤患者,其低钠血症、高钠血症、低钾血症发生的严重程度均具有统计学差异(p0.05);不同严重程度低钠血症患者的GOS预后差异无统计学意义(p0.05);不同严重程度的高钠血症和低钾血症的GOS预后的差异具有统计学意义(p0.05);所有118例患者中,出现2例高钾血症。结论颅脑创伤后出现的水电解质紊乱主要有低钠血症、高钠血症和低钾血症,在我们的研究中并未发现有高钾血症的发生。低钠血症的严重程度与损伤程度无相关关系,而高钠血症和低钾血症的严重程度与损伤程度密切相关;严重的低钠血症、高钠血症和低钾血症常常发生在颅脑创伤后的早期,通常是在第1天至第3天内,且后两者与患者的预后密切相关,应该及时发现并纠正;低钠血症、高钠血症和低钾血症的严重程度和损伤部位密切相关。
[Abstract]:Background and objective Analysis of the causes of death in patients with craniocerebral trauma in neurosurgery showed that 62% of the patients died of various complications after traumatic brain injury.However, due to the disturbance of endocrine function after traumatic brain injury, water and electrolyte disturbance, and the balance of internal environment are destroyed, the death cases are not uncommon.The main reason is that craniocerebral trauma may lead to the injury of hypothalamus-pituitary connection system, and cause pathological stress response, and then lead to water electrolyte disorder or damage or failure of multi-organ function.The disturbance of water and electrolyte in patients with traumatic brain injury (TBI) has long plagued many medical workers, including hyponatremia, hypernatremia, and hypokalemia.Failure to correct the water-electrolyte disorder in time can lead to a decrease in the patient's prognostic level.However, the clinicians do not know enough about the water electrolyte disorder after traumatic brain injury, the regularity of its occurrence is not clear, and there are few related studies.Therefore, it is of great significance to master the characteristics and influencing factors of water and electrolyte disorders in patients with traumatic brain injury.Methods the detailed clinical data of 118 patients with craniocerebral trauma in our hospital were analyzed retrospectively, and the time rule of water electrolyte disturbance was discussed, and the influencing factors of different types and severity of water electrolyte disturbance were analyzed.It includes hyponatremia, hypernatremia, hypokalemia and hyperkalemia.Results there was no significant difference in the severity of hyponatremia in patients with different severity of craniocerebral trauma, but there was no significant difference in the severity of hyponatremia in patients with different severity of craniocerebral trauma.There were significant differences between the occurrence of hypernatremia and hypokalemia and the severity of injury (p0.05); severe hyponatremia, hypernatremia and hypokalemia usually occurred 1-3 days after injury; patients with traumatic brain injury at different sites had hyponatremia.Hypernatremia,The severity of hypokalemia had statistical difference (p 0.05), the prognosis of GOS in patients with different severity of hyponatremia had no significant difference (p 0.05), and the prognosis of GOS with different severity of hypernatremia and hypokalemia was different.In all 118 patients,There were 2 cases of hyperkalemia.Conclusion there are mainly hyponatremia, hypernatremia and hypokalemia after traumatic brain injury. There is no hyperkalemia in our study.There was no correlation between the severity of hyponatremia and the degree of injury, but the severity of hypernatremia and hypokalemia was closely related to the degree of injury, and severe hyponatremia, hypernatremia and hypokalemia often occurred early after traumatic brain injury.It is usually within the first to third day, and the latter two are closely related to the prognosis of the patients, should be found and corrected in time, hyponatremia, hypernatremia and hypokalemia are closely related to the severity and location of injury.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.15

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