87例肺心病低钠血症临床研究.doc

87例肺心病低钠血症临床研究[摘要] 目的：探讨慢性肺心病合并低钠血症的防治措施。方法：对87例慢性肺心病低钠血症患者的临床资料进行回顾性分析。结果：肺心病低钠血症发生率为30.1%。低钠血症并发低渗性脑病时易误诊为肺性脑病，误诊率为32.0%。肺心病并低钠血症经及时诊治，预后良好，治愈率达90.8%。结论：低钠血症是肺心病常见并发症，低钠血症引起的低渗性脑病易误诊为肺性脑病。正确诊治肺心病低钠血症对预后至关重要。 [关键词] 肺心病；低钠血症；低渗性脑病；肺性脑病 [中图分类号]R541[文献标识码]C [文章编号]1673-7210（2007）11（b）-141-01 Clinical analysis of hyponatremia in 87 cases with pneumocardial diseaseWAN Wen-bin, YANG Yu-lan , LI Wen-peng (Medical Department of the First Peoples Hospital of Dali,Dali 671000, China) [Abstract] Objective: To investigate the prevention and therapy way of the complication of hyponatremia in chronic pulmonary heart disease. Methods： The clinical data of the complication of hyponatremia in 87 patients with chronic pulmonary heart disease was analyzed in retrospect.Results： The incidence of the complication of hyponatremia in chronic pulmonary heart disease was 30.1%. As cases complicated hypotonic encephalopathy, the pulmonary encephalopathy was easy to be misdiagnosed,the misdiagnosis rate is 32.0%. By treatment to the the complication of hyponatremia with chronic pulmonary heart disease, the cure rate was 90.8%.Conclusion：The hyponatremia was a common complication at pneumocardial disease. As cases complicated with hypotonic encephalopathy, the pulmonary encephalopathy was easy to be misdiagnosed. The correct diagnosis and treatment to the hyponatremia in pneumocardial disease are essential to prognosi. [Key words] Pulmonary heart disease；Hyponatremia； Hypotonic encephalopathy；Pulmonary encephalopathy 低钠血症是肺心病常见并发症，易漏诊、误诊，临床表现复杂多样，与病人预后关系密切，不及时诊治会贻误疾病治疗。现将我科1997 年1 月～2006年8月收治的289例肺心病患者中并发低钠血症87例分析如下： 1 资料及方法 1.1 一般资料 87例均为低钠血症住院患者，其中，男77 例，女10例；发病年龄63～90 岁，平均年龄72岁。均系慢性肺心病急性发作期患者，肺心病病程7～23年，平均17.6年。其中，1型呼衰11例，2型呼衰76例，同时合并肺性脑病20例。另外，87例低钠血症患者中合并低渗性脑病25例(部分病例与肺性脑病并存)，呼吸性酸中毒合并代偿性碱中毒29例，死亡8例。 87例低钠血症患者的肺心病诊断均符合1980 年全国第三次肺心病会议制订的标准。肺部原发病包括：慢性阻塞性肺疾病(COPD)65例，支气管哮喘10例，肺结核8例，支气管扩张4例。病因分别是：右心衰及长期使用利尿剂、长期忌盐、纳差、高碳酸血症、长期大量出汗、输注过多单纯葡萄糖同时补充盐水少等。其中，37 例为稀释性低钠