Clinical Study Of The Subsequent Hyponatremia In Intracranial Disorders After Craniocerebal Injury

Objective:Through clinical observation of subsequent hyponatremia after craniocerebral injury, we will attempt to find out the rule of causing hyponatremia in intracranial disordes in order to provide better clinical validation and correlative theoretic basis. Method:This thesis chooses randomly 60 patients of craniocerebral injury with blood serum natrium <135mmol/l and GCS≤12 , and randomly 30 patients of head injury with normal blood serum natrium as its comparison; observes the time of their occurring hyponatremia, meanwhile; monitors their urine natrium in 24 hours; blood serum natrium, CVP, BOP(blood osmotic pressur),HCT, and HB everyday; observes their change of every items 3 days before supply natrium and 2days after supplying natrium; or 6 days after limiting water.Grouping: we define low blood serum natrium and urine natrium<80mmol/l as the group of nutrien hyplonatremia, define low blood serum natrium and urine natrium>80mmol/l and efficiency with supplying natrium as the group of CSWS, defined low blood natrium and urine natrium>80mmol/l and inefficiency with supplying natrium but efficiency with limiting water as the group of SIADH.This thesis has analyzed statistically all data as the following:1 This thesis describes the even means of blood serum natrium, urine natrium and other observational markers in four groups with Bar Chart or/and x±s,to deseribe the change tendency of urine natrium with Line Chart.2 This thesis uses the Mann-Whitney to analysis the correlation of GCS and incidence rate of hyponatremia after craniocerebral injury.3 This thesis compares respectively with t-test the differences of episode time,CVP,HCT, and HB between in group CSWS and in group SIADH .4 This thesis uses the One-Way ANOVA to compare respectively the differences of BOP, urine density, urine natrium in three groups of nutrien hyponatremia, CSWS and SIADH .5 This thesis uses t-test to compare respectively the changes of blood serum natrium and urine natrium before and after supplying natriumor limiting water, two groups of CSWS and SIADH. Result:1 The group of nutrien hyponatremia has 44 cases, consisting 73.33%; The group of CSWS has 10 cases, consisting 16.67%; the group of SIADH has 6 cases, consisting 10%.2 The most distinct differences between CSWS and SIADH with nutrien hyponatremia are low blood serum natrium with increase of urine natrium, and the urine natrium tending to increase gradually.3 The hyponatremia after head injury occurs more frequently in serious craniocerebral injury. The CSWS is often observed in clinical. The total incidence rate of serious craniocerebral injury is 60.87%(14/23) in our observing cases, the CSWS occupying 39.13%(9/23), the SIADH 21.74%(5/23).4 The diagnosis of CSWS and SIADH can be completely confirmed through clinical observing markers and supplying natrium or limiting water test. (1) the diagnostic criterion of CSWS: blood serum natrium<130mmol/l, urine natrium>80mmol/24h, CVP<6cmH2O, HCT>0.45, HB>13.5g/l, to episode after one week of craniocerebral injury, efficiency for supplying natrium test and existing clinical situation of hyponatremia. (2) the diagnostic criterion of SIADH: blood serum natrium<130mmol/l, urine natrium>80mmol/24h, CVP>10cmH2O, HCT<0.45, HB<13.5g/l, to episode within one weekof craniocerebral injury, inefficiency for supplying natrium but efficiency for limiting water test and existing clinical situation of hyponatremia.5 There is statistic significance of CVP, blood serum natrium after supplying natrium or limiting water, episode time, HCT and HB between CSWS and SIADH, but no statistic significance of blood serum natrium, urine natrium, BOP, urine density. Conclusion:The subsequent hyponatremia in intracranial disorders after head injury occurs more frequently in serious craniocerebral injury, and the CSWS is often observed in clinical. There are radically differences between CSWS and SIADH. Their...