Laine J, Holmberg C, Anttila M, Peltola H, Perheentupa J
Children's Hospital, University of Helsinki, Finland.
Acta Paediatr Scand. 1991 Nov;80(11):1031-6. doi: 10.1111/j.1651-2227.1991.tb11779.x.
As part of a prospective study of children with bacterial meningitis we analyzed in 36 patients of our hospital the fluid balance on admission and during the first three days of treatment. On admission 10 of them (28%) had inappropriate antidiuretic hormone secretion SIADH, 10 (28%) hypo-osmolal and 10 (28%) iso-osmolal contraction. Six patients (17%) had no clear fluid disorder. The patients with SIADH had significantly lower mean serum NA+ (127 vs. 132 mEq/l, p less than 0.01) and higher mean urine Na+ (111 vs. 26 mEq/l, p less than 0.01) concentration as well as higher mean urinary Na+/K+ ratio (2.23 vs. 0.365, p less than 0.005) than the patients with hypo-osmolal contraction. They also tended to be younger and have a shorter history of fever. The patients with SIADH had a less strict fluid restriction than the patients with hypo-osmolal contraction, and their fluid balance normalized more slowly. Our findings support initial water restriction for all children with bacterial meningitis.
作为一项对细菌性脑膜炎患儿的前瞻性研究的一部分，我们分析了我院36例患者入院时及治疗头三天的液体平衡情况。入院时，其中10例（28%）患有抗利尿激素分泌不当综合征（SIADH），10例（28%）为低渗性，10例（28%）为等渗性浓缩。6例患者（17%）无明显液体紊乱。与低渗性浓缩患者相比，SIADH患者的平均血清钠浓度显著降低（127 vs. 132 mEq/l，p<0.01），平均尿钠浓度更高（111 vs. 26 mEq/l，p<0.01），平均尿钠/钾比值也更高（2.23 vs. 0.365，p<0.005）。他们往往年龄更小，发热病史更短。与低渗性浓缩患者相比，SIADH患者的液体限制不那么严格，其液体平衡恢复正常的速度也更慢。我们的研究结果支持对所有细菌性脑膜炎患儿最初进行水限制。
