本文選題：顱腦創(chuàng)傷　切入點(diǎn)：低鈉血癥　出處：《南方醫(yī)科大學(xué)》2017年碩士論文

【摘要】：研究背景及目的神經(jīng)外科的患者中,對(duì)于顱腦創(chuàng)傷的死亡原因的分析顯示,約有62%的患者是死于顱腦創(chuàng)傷后的各種并發(fā)癥,而在這當(dāng)中由于顱腦創(chuàng)傷后內(nèi)分泌功能障礙導(dǎo)致水電解質(zhì)紊亂,進(jìn)而內(nèi)環(huán)境平衡遭到破壞,由此引起的死亡病例并不少見。其原因主要是由于顱腦創(chuàng)傷可能導(dǎo)致下丘腦-垂體這一聯(lián)系系統(tǒng)的損傷,引起病理性的應(yīng)激反應(yīng),進(jìn)而導(dǎo)致水電解質(zhì)紊亂或是多臟器功能受到損害或衰竭。顱腦創(chuàng)傷后患者的水電解質(zhì)紊亂長期困擾著廣大醫(yī)療工作者,包括低鈉血癥、高鈉血癥、及低鉀血癥等。水電解質(zhì)紊亂不能得到及時(shí)糾正會(huì)導(dǎo)致患者預(yù)后水平的下降。但是臨床醫(yī)生對(duì)顱腦創(chuàng)傷后水電解質(zhì)紊亂的認(rèn)識(shí)不足,對(duì)其發(fā)生的規(guī)律不清楚,相關(guān)研究也較少。因此掌握顱腦創(chuàng)傷患者水電解質(zhì)紊亂的特點(diǎn)及其影響因素具有重要的意義。研究方法回顧性分析我院神經(jīng)外科118例顱腦創(chuàng)傷患者的詳細(xì)臨床資料,探討水電解質(zhì)紊亂發(fā)生的時(shí)間規(guī)律,分析不同類型、不同嚴(yán)重程度水電解質(zhì)紊亂相關(guān)的影響因素,包括低鈉血癥、高鈉血癥、低鉀血癥和高鉀血癥,并分析其與預(yù)后的關(guān)系。結(jié)果不同嚴(yán)重程度的顱腦創(chuàng)傷患者,其低鈉血癥的嚴(yán)重程度無顯著差異(p=0.639);不同嚴(yán)重程度的顱腦創(chuàng)傷患者,其高鈉血癥及低鉀血癥的發(fā)生與損傷的嚴(yán)重程度具有顯著差異(p0.05);嚴(yán)重的低鈉血癥、高鈉血癥和低鉀血癥通常出現(xiàn)在傷后1-3天;不同受傷部位的顱腦創(chuàng)傷患者,其低鈉血癥、高鈉血癥、低鉀血癥發(fā)生的嚴(yán)重程度均具有統(tǒng)計(jì)學(xué)差異(p0.05);不同嚴(yán)重程度低鈉血癥患者的GOS預(yù)后差異無統(tǒng)計(jì)學(xué)意義(p0.05);不同嚴(yán)重程度的高鈉血癥和低鉀血癥的GOS預(yù)后的差異具有統(tǒng)計(jì)學(xué)意義(p0.05);所有118例患者中,出現(xiàn)2例高鉀血癥。結(jié)論顱腦創(chuàng)傷后出現(xiàn)的水電解質(zhì)紊亂主要有低鈉血癥、高鈉血癥和低鉀血癥,在我們的研究中并未發(fā)現(xiàn)有高鉀血癥的發(fā)生。低鈉血癥的嚴(yán)重程度與損傷程度無相關(guān)關(guān)系,而高鈉血癥和低鉀血癥的嚴(yán)重程度與損傷程度密切相關(guān);嚴(yán)重的低鈉血癥、高鈉血癥和低鉀血癥常常發(fā)生在顱腦創(chuàng)傷后的早期,通常是在第1天至第3天內(nèi),且后兩者與患者的預(yù)后密切相關(guān),應(yīng)該及時(shí)發(fā)現(xiàn)并糾正;低鈉血癥、高鈉血癥和低鉀血癥的嚴(yán)重程度和損傷部位密切相關(guān)。
[Abstract]:Background and objective Analysis of the causes of death in patients with craniocerebral trauma in neurosurgery showed that 62% of the patients died of various complications after traumatic brain injury.However, due to the disturbance of endocrine function after traumatic brain injury, water and electrolyte disturbance, and the balance of internal environment are destroyed, the death cases are not uncommon.The main reason is that craniocerebral trauma may lead to the injury of hypothalamus-pituitary connection system, and cause pathological stress response, and then lead to water electrolyte disorder or damage or failure of multi-organ function.The disturbance of water and electrolyte in patients with traumatic brain injury (TBI) has long plagued many medical workers, including hyponatremia, hypernatremia, and hypokalemia.Failure to correct the water-electrolyte disorder in time can lead to a decrease in the patient's prognostic level.However, the clinicians do not know enough about the water electrolyte disorder after traumatic brain injury, the regularity of its occurrence is not clear, and there are few related studies.Therefore, it is of great significance to master the characteristics and influencing factors of water and electrolyte disorders in patients with traumatic brain injury.Methods the detailed clinical data of 118 patients with craniocerebral trauma in our hospital were analyzed retrospectively, and the time rule of water electrolyte disturbance was discussed, and the influencing factors of different types and severity of water electrolyte disturbance were analyzed.It includes hyponatremia, hypernatremia, hypokalemia and hyperkalemia.Results there was no significant difference in the severity of hyponatremia in patients with different severity of craniocerebral trauma, but there was no significant difference in the severity of hyponatremia in patients with different severity of craniocerebral trauma.There were significant differences between the occurrence of hypernatremia and hypokalemia and the severity of injury (p0.05); severe hyponatremia, hypernatremia and hypokalemia usually occurred 1-3 days after injury; patients with traumatic brain injury at different sites had hyponatremia.Hypernatremia,The severity of hypokalemia had statistical difference (p 0.05), the prognosis of GOS in patients with different severity of hyponatremia had no significant difference (p 0.05), and the prognosis of GOS with different severity of hypernatremia and hypokalemia was different.In all 118 patients,There were 2 cases of hyperkalemia.Conclusion there are mainly hyponatremia, hypernatremia and hypokalemia after traumatic brain injury. There is no hyperkalemia in our study.There was no correlation between the severity of hyponatremia and the degree of injury, but the severity of hypernatremia and hypokalemia was closely related to the degree of injury, and severe hyponatremia, hypernatremia and hypokalemia often occurred early after traumatic brain injury.It is usually within the first to third day, and the latter two are closely related to the prognosis of the patients, should be found and corrected in time, hyponatremia, hypernatremia and hypokalemia are closely related to the severity and location of injury.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R651.15

【參考文獻(xiàn)】

相關(guān)期刊論文 前6條

1 潘玨恒;鄭穎鋒;韋璽;;顱腦損傷早期低鉀血癥與預(yù)后的關(guān)系[J];中國醫(yī)藥導(dǎo)報(bào);2011年30期

2 孫彤;辛星;;開顱術(shù)后或腦損傷并發(fā)高鈉血癥68例患者的預(yù)后分析[J];現(xiàn)代預(yù)防醫(yī)學(xué);2011年06期

3 雷德強(qiáng);趙洪洋;;中樞性低鈉血癥[J];中國臨床神經(jīng)外科雜志;2008年01期

4 安振梅,魏松全,張存泓;低鉀血癥[J];國外醫(yī)學(xué)(內(nèi)科學(xué)分冊(cè));2001年01期

5 梁冶矢,欒文忠;重型顱腦損傷與高鈉血癥[J];中華創(chuàng)傷雜志;1997年06期

6 張靖源;關(guān)茂武;;中、重度顱腦外傷并發(fā)低鈉血癥的治療體會(huì)[J];中華神經(jīng)外科雜志;2009年07期

相關(guān)碩士學(xué)位論文 前1條

1 吳瓊;高鈉血癥對(duì)重癥監(jiān)護(hù)病房患者預(yù)后影響的薈萃分析[D];鄭州大學(xué);2014年

，

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