頭部外傷後の高ナトリウム血症に対する等Ｎａ濃度輸液を用いた体液量補正法の有効性

DOI 被引用文献1件 参考文献21件

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  • Volume Replacement Using Iso-Sodium Solution Prevents Hypernatremia Following Head Injury.

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Background; Hypernatremia is one of the most fatal complications following head injury and should be treated in its early stages. The cause of this complication is hypertonic dehydration following loss of free water due to urinary hypoosmolarity. We hypothesized that early replacement of the loss of water would be essential to prevent and improve the hypernatremia. Methods; Sudden hypoosmolarity of urine (<300mOsm/l) was observed in fifteen head injured patients through out the first seven days after the injury. An iso-sodium solution was infused to maintain positive water balance in the subjects. The sodium concentration of the solution was changed every 8-hours to be equal to those of the serum so as not to aggravate brain swelling. Arginine vasopressin (AVP) was added to those who excreted a large quantity of urine (>500ml/hr) in order to decrease the amount of infusion. Results; We successfully prevented an increase in serum sodium concentration in 13 patients, 8 of whom received only volume replacement (VR): VR effective group. The other five required the addition of AVP: VR+AVP effective group. We failed to prevent the aggravation of hypernatremia in two patients: VR ineffective group. Positive water balance was achieved in all groups. The urinary sodium concentration was elevated after 24-hour volume manipulation in the VR effective (33±21 vs 123±21mEq/l, mean±SD, p<0.05 by ANOVA)and VR+AVP effective groups (41±19 vs 223±45mEq/l, p<0.05 by ANOVA), but not in the VR ineffective group (39±12 vs 27±8mEq/l). Creatinine clearance in the VR effective and VR+AVP effective groups was increased, while it was decreased in the VR ineffective group. Intracranial pressure (ICP) did not elevate due to the volume manipulation. Conclusions; Hypernatremia following head injury should be treated in the early stages. Volume replacement using iso-sodium solution is effective and safe for preventing the aggravation of hypernatremia.

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