Audibert G, Hoche J, Baumann A, Mertes P-M
Service d'anesthésie-réanimation, hôpital Central, CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France.
Ann Fr Anesth Reanim. 2012 Jun;31(6):e109-15. doi: 10.1016/j.annfar.2012.04.014. Epub 2012 Jun 7.
Electrolyte disturbances are frequent after brain injuries, especially dysnatremia and dyskalemia. In neurological patients, usual clinical signs of hyponatremia are frequently confounded with clinical signs of the underlying disease. Natremia absolute value is less important than speed of onset of the trouble. Most often, hyponatremia is associated with hypotonicity and intracellular hyperhydration, which may exacerbate a cerebral edema. Distinction between inappropriate secretion of antidiuretic hormone (SIADH) and cerebral salt wasting syndrome (CSWS) may be difficult and is mainly based on assessment of patient's volemia, SIADH being associated with normal or hypervolemia and CSWS with hypovolemia. After subarachnoid haemorrhage, the most common disorder is CSWS. In this case, fluid restriction is strictly prohibited. Treatment of CSWS needs to compensate for the natriuresis and may justify the use of mineralocorticoid. It is important to avoid excessively rapid correction of hypernatremia, with a maximal speed of correction of 0.5 m mol/l/h. Serum sodium monitoring should be mandatory for the first ten postoperative days after pituitary adenoma surgery. Therapeutic barbiturate may be responsible for life threatening dyskalemia.
脑损伤后电解质紊乱很常见，尤其是钠代谢紊乱和钾代谢紊乱。在神经系统疾病患者中，低钠血症的常见临床体征常常与基础疾病的临床体征相混淆。血钠绝对值不如病情发作速度重要。低钠血症通常与低渗和细胞内水合过多有关，这可能会加重脑水肿。抗利尿激素分泌不当综合征（SIADH）和脑性盐耗综合征（CSWS）之间的区分可能很困难，主要基于对患者血容量的评估，SIADH与血容量正常或增加有关，而CSWS与血容量减少有关。蛛网膜下腔出血后，最常见的紊乱是CSWS。在这种情况下，严格禁止液体限制。CSWS的治疗需要补充尿钠，这可能说明使用盐皮质激素是合理的。重要的是要避免过快纠正高钠血症，最大纠正速度为0.5 mmol/L/小时。垂体腺瘤手术后的头十天必须进行血清钠监测。治疗用巴比妥酸盐可能导致危及生命的钾代谢紊乱。
