Jiménez Raquel, Casado-Flores Juan, Nieto Monserrat, García-Teresa María Angeles
Pediatric Intensive Care Unit, Hospital Infantil Niño Jesús, Universidad Autónoma, Madrid, Spain.
Pediatr Neurol. 2006 Oct;35(4):261-3. doi: 10.1016/j.pediatrneurol.2006.05.004.
The purpose of this investigation was to describe the causes, clinical pattern, and treatment of cerebral salt wasting syndrome in children with acute central nervous system injury. This retrospective study focused on patients<or=15 years old diagnosed with cerebral salt wasting syndrome, over a period of 7 years, in the pediatric intensive care unit of a tertiary care hospital. Selection criteria included evidence of hyponatremia (serum sodium<130 mEq/L), polyuria, elevated urine sodium (>120 mEq/L), and volume depletion. Fourteen patients were identified with cerebral salt wasting syndrome, 12 after a neurosurgical procedure (8 brain tumor, 4 hydrocephalus) and 2 after severe brain trauma. In 11 patients the cerebral salt wasting syndrome was diagnosed during the first 48 hours of admission. Prevalence of cerebral salt wasting syndrome in neurosurgical children was 11.3/1000 surgical procedures. The minimum sodium was 122+/-7 mEq/L, the maximum urine osmolarity 644+/-59 mOsm/kgH2O. The maximum sodium supply was 1 mEq/kg/h (range, 0.1-2.4). The mean duration of cerebral salt wasting syndrome was 6+/-5 days (range 1-9). In conclusion, cerebral salt wasting syndrome can complicate the postoperative course of children with brain injury; it is frequently present after surgery for brain tumors and hydrocephalus and in patients with severe head trauma. Close monitoring of salt and fluid balance is essential to prevent severe neurologic and hemodynamic complications.
本研究旨在描述急性中枢神经系统损伤患儿脑性盐耗综合征的病因、临床模式及治疗方法。这项回顾性研究聚焦于一家三级医院儿科重症监护病房中7年间诊断为脑性盐耗综合征且年龄≤15岁的患者。入选标准包括低钠血症（血清钠<130 mEq/L）、多尿、尿钠升高（>120 mEq/L）及容量耗竭的证据。共确定14例脑性盐耗综合征患者，12例在神经外科手术后（8例脑肿瘤，4例脑积水），2例在严重脑外伤后。11例患者在入院的头48小时内被诊断为脑性盐耗综合征。神经外科患儿脑性盐耗综合征的患病率为11.3/1000例手术。最低血清钠为122±7 mEq/L，最高尿渗透压为644±59 mOsm/kgH₂O。最大钠补充量为1 mEq/kg/h（范围0.1 - 2.4）。脑性盐耗综合征的平均持续时间为6±5天（范围1 - 9天）。总之，脑性盐耗综合征可使脑损伤患儿的术后病程复杂化；在脑肿瘤和脑积水手术后以及重度颅脑外伤患者中经常出现。密切监测盐和液体平衡对于预防严重的神经和血流动力学并发症至关重要。
