Brown R G
McLennan County Medical Education and Research Foundation, Waco, TX 76707.
Postgrad Med. 1993 Mar;93(4):227-8, 231-4, 239-40 passim. doi: 10.1080/00325481.1993.11701649.
The serum sodium concentration reflects a patient's relative water balance and thus determines if the patient needs more or less water than normal maintenance needs would dictate. The serum sodium concentration has no bearing on whether a patient requires sodium restriction or saline administration. Rather, the sodium/saline balance is determined by clinical assessment of the patient's extracellular fluid volume. Physicians must clearly understand the principles involved when assessing a patient's water and sodium needs. After maintenance water needs and any foreseeable ongoing losses have been factored in, an intelligent plan of fluid management can be initiated. Frequent reassessments, with serial weight measurements, clinical evaluations of extracellular fluid volume status, and determinations of serum sodium concentration, are essential to determine if the desired therapeutic goals are being reached.
血清钠浓度反映了患者相对的水平衡，从而决定患者所需的水量是多于还是少于正常维持需求所规定的量。血清钠浓度与患者是否需要限制钠摄入或给予生理盐水无关。相反，钠/生理盐水平衡是通过对患者细胞外液量的临床评估来确定的。医生在评估患者的水和钠需求时必须清楚地理解其中涉及的原理。在考虑了维持水需求和任何可预见的持续失液后，即可启动合理的液体管理计划。通过连续测量体重、对细胞外液量状态进行临床评估以及测定血清钠浓度进行频繁的重新评估，对于确定是否达到预期治疗目标至关重要。
