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:2010-01-17;:2010-03-15:(1978-),,,,:,,,,,:56范存刚综述张庆俊审校n北京大学人民医院神经外科,北京100044:,,200956,,:;;;,50%[1-6],[6],,(osmoticdemyelinatingsyndrome,ODS)[6,7],2009,(syndromeofinappropriateant-idiuretichormone,SIADH)(cerebralsaltwasting,CSW)[8],1,19502008PubMedCochraneSIADHCSW,Walters[9]2,135mmol/L,[10],,130mmol/L,131mmol/L(II)[8]3,,(III),(III)131mmol/L,(ex-tracellularfluid,ECF)(285mOs/kg)(285mOs/kg)ECF:¹()(CSW);200mOs/kg,25mmol/L25mmol/Lº,(thyroid-stmiulatinghormone,TSH)(freethyroxine,FT4),SIADH(100mOs/kg25mOs/kg)(TSHFT4)()(100mOs/kg)#158#JournalofInternationalNeurologyandNeurosurgery2010,37(2)»,,[8]4CSWSIADHCSWSIADH,CSW,[11]SIADH,,,,[12],CSWSIADH,,(1)1CSWSIADH检测项目CSWSIADH血清钠,mmol/L*135135血清渗透压,mOsm/kg*285285尿渗透压,mOsm/kg*200200尿钠,mmol/L2525体重|{液体平衡|{颈静脉充盈)+红细胞压积{|血尿素氮{|肌酐{|尿酸||中心静脉压,cmH2O66肺楔压,mmHg88*至少符合这些标准并至少满足其他标准中的3条才能诊断55.1(Centralpontinemyelinolysis)ODS[7,13],ODS(48)(),12mmol/L/d,ODS[14]1mmol/L/h()/(48)[8]5.2SIADHSIADH,,,SIADH:SAHSIADH/66mmol/L,182mmol/L,248mmol/L[8],131mmol/L,SIADH(1)1SIADH(HHH,hypervolemia,hypertension,hemodilution;)5.3CSWCSW,SAHCSW#159#2010372/66mmol/L,66mmol/L182mmol/L,248mmol/L,131mmol/L,(subarachnoidhemorrhage,SAH)131~135mmol/L[8],CSW(2)2CSW6,,[15]131mmol/L,,TSHFT4,(CVP)(PCWP)CSWSIADH(III);8~10mmol/L/d(III);CSW(III);SAH,SAH(I);SAH(II);SIADH/(III)[1]UpadhyayA,JaberBL,MadiasNE.Incidenceandpreva-lenceofhyponatremia.AmJMed.2006,119(7Suppl):S30-35.[2]SherlockM,O'SullivanE,AghaA,etal.Incidenceandpathophysiologyofseverehyponatraemiainneurosurgicalpa-tients.PostgradMedJ,2009,85(1002):171-175.[3]KristofRA,RotherM,NeulohG,etal.Incidence,clinicalmanifestations,andcourseofwaterandelectrolytemetabolismdisturbancesfollowingtranssphenoidalpituitaryadenomasurgery:aprospectiveobservationalstudy.JNeurosurg,2009,111(3):555-562.[4]BedersonJB,ConnollyESJr,BatjerHH,etal.Guidelinesforthemanagementofaneurysmalsubarachnoidhemorrhage:astatementforhealthcareprofessionalsfromaspecialwritinggroupoftheStrokeCouncil,AmericanHeartAssociation.Stroke.2009,40(3):994-1025.[5]Donati-GenetPC,DubuisJM,GirardinE,etal.Acutesymptomatichyponatremiaandcerebralsaltwastingafterheadinjury:animportantclinicalentity.JPediatrSurg,2001,36(7):1094-1197.[6]FraserJF,StiegPE.Hyponatremiaintheneurosurgicalpa-tient:epidemiology,pathophysiology,diagnosis,andmanage-ment.Neurosurgery,2006,59(2):222-229;discussion222-229.[7]TsutsumiS,YasumotoY,ItoM.Centralpontineandextrap-ontinemyelinolysisinaninfantassociatedwiththetreatmentofcraniopharyngioma:casereport.NeurolMedChir,2008,48(8):351-354.[8]RahmanM,FriedmanWA.Hyponatremiainneurosurgicalpa-tients:clinicalguidelinesdevelopment.Neurosurgery.2009,65(5):925-935.[9]BeanJR.NeurosurgeryinTransition:TheSocioeconomicTrans-formationofNeurologicalSurgery(ConceptsinNeurosurgery).1ed,Lexington:Williams&Wilkins,1998.99-111.[10]JanicicN,VerbalisJG.Evaluationandmanagementofhypo-osmolalityinhospitalizedpatients.EndocrinolMetabClinNAm,2003,32(2):459-481.[11]SternsRH,SilverSM.CerebralsaltwastingversusSIADH:whatdifference?JAmSocNephrol,2008,19(2):194-196.[12]Cerd-EsteveM,Cuadrado-GodiaE,ChillaronJJ,etal.Cerebralsaltwastingsyndrome:review.EurJInternMed,2008,19(4):249-254.#160#JournalofInternationalNeurologyandNeurosurgery2010,37(2)[13]KawaharaI,TokunagaY,IshizakaS,etal.Reversibleclin-icalandmagneticresonanceimagingofcentralpontinemyel-inolysisfollowingsurgeryforcraniopharyngioma:serialmagneticresonanceimagingstudies.NeurolMedChir,2009,9(3):120-123.[14]LohrJW.Osmoticdemyelinationsyndromefollowingcorrectionofhyponatremia:associationwithhypokalemia.AmJMed,1994,96(5):408-413.[15],,.(128).,2009,36(1):5-8.:2010-01-24;:2010-03-22:(1972-),,,NSE张刚利综述张汉伟审校山西省人民医院神经外科,山西太原030012:(NSE),,NSE,NSENSE:;;,,,(GCS)(GOS),(neuron-specificenolase,NSE)[1-2],NSE1NSERoyds[3]1215(),AABBCCABACCC,(NSE)NSE80kd,,[4]NSE,NSE,,,[5]NSE()()C(AC),30~50,,NSE[6]NSE3~8ng/ml[7],,NSE,NSE[8,9]NSE2NSE,,,NSE#161#2010372