探讨高渗盐水在神经外科患者由低钠血症导致脑疝等病情恶化的治疗作用。

回顾性分析2014年1月至2016年11月山东大学第二医院神经外科应用高渗盐水治疗的5例由于低钠血症引起脑疝的神经外科患者的临床资料，包括颅脑外伤、颅内肿瘤、颅内动脉瘤破裂致蛛网膜下腔出血的情况。患者于发病、手术后4~16 d由于低钠血症引起脑肿胀、颅内压升高、脑疝。在出现低钠、脑疝后，立即进行2%高渗盐水治疗，治疗目标为保持血钠于145~155 mmol/l。

经高渗盐水、纠正低钠治疗后病情改善。5例患者均脑疝逆转，未行去骨瓣减压术等手术治疗。脑疝发生时血钠水平为（121.80±5.12）mmol/l，病情缓解时为（144.60±5.13）mmol/l，配对t检验显示2组间差异有统计学意义（t=-5.419，P<0.05）。5例患者均顺利恢复。出院时GOS评分Ⅴ级4例，Ⅳ级1例。未出现脑桥中央髓鞘溶解等并发症。

神经外科重症患者脑水肿时间长、机制复杂，易于出现水电解质紊乱；低钠可引起脑肿胀、颅内压升高、脑疝，具有发病突然、病情恶化快等特点；此时积极补钠治疗可收到良好的效果，甚至逆转脑疝，取得良好预后。

To explore the treatment effect of hypertonic saline on the brain herniation due to hyponatremia in Neurosurgery patient.

The clinical data of 5 patients enrolled in our department from January 2014 to November 2016 were retrospectively analyzed. All the neurosurgery patients had brain herniation due to hyponatremia. Their diagnoses included head trauma, brain tumor, and spontaneous subarachnoid hemorrhage due to aneurysm. The brain herniation happened 4 to 16 d after brain injury or operation, because of the increased intracranial pressure (ICP) due to hyponatremia and brain edema subsequently. As the brain herniation occurred due to hyponatremia, the infusion of 2% hypertonic saline was intitated immediately. The goal of treatment was the serum sodium level being 145-155 mmol/l.

The patients accepted hypertonic saline injection immediately, and the conditions ameliorated when the hyponatremia was corrected. The brain herniation was reversed, and no patient underwent decompressive craniectomy. The serum sodium level when brain herniation occurred was (121.80±5.12) mmol/l, then increased to (144.60±5.13) mmol/l when the brain herniation was reversed. The paired t test showed the difference between the two groups of the serum sodium levels was statistically significant (t=-5.419, P<0.05). The 5 patients were all recovered smoothly. The GOS of 4 patients were 5, and 1 patient scored 4. No complications such as central pontine myelinolysis occurred.

The brain edema duration of Neurosurgery patients is prolonged, and the pathophysiology of brain edema is complex, so water-electrolyte disturbance is readily to occur. Hyponatremia may cause brain edema and increased ICP, even brain herniation, with the characteristic of sudden onset and fast exacerbation. Hypertonic saline infusion could have potent effect to ameliorate such condition, may even reverse brain herniation and gain good outcome.