低钠血症的诊断思路课件

,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Beijing Hospital of Traditional Chinese Medicine,*,低钠血症的临床意义,钠,:,机体血液渗透压的主要决定因子，,调节细胞外液容积，,影响血压及组织器官灌注。,体内钠总量,ECF,血压,组织器官灌注,低钠血症的临床意义 钠:机体血液渗透压的主要决定因子，,低钠血症的临床意义,常见的电解质紊乱：,15%,的住院患者,尤其是重症监护室：,丧失自主行为能力；,水钠平衡调节能力下降,老年人,神经科病人,昏迷,插管,Beijing Hospital of Traditional Chinese Medicine,2024/11/12,低钠血症的临床意义常见的电解质紊乱：Beijing Hosp,低钠血症的临床意义,症状及体征与血钠的水平,血钠异常主要影响,神经、胃肠道,和,神经肌肉,的功能。,血清钠,125mmol/L,，多无症状,血清钠,125mmol/L,，,GI,症状,血清钠,120mmol/L,出现,NS,症状,血清钠,110mmol/L,，抽搐、昏迷,发生速度、年龄,Beijing Hospital of Traditional Chinese Medicine,2024/11/12,低钠血症的临床意义症状及体征与血钠的水平Beijing Ho,低钠血症的临床意义,中枢神经系统,轻度：冷漠，头痛，昏睡,中度：兴奋，运动失调，混乱，定向力障碍，,精神异常,重度：木僵，昏迷，假性延髓麻痹，死亡,胃肠道,厌食,恶心,呕吐,肌肉运动系统,肌肉痉挛,腱反射减弱,Beijing Hospital of Traditional Chinese Medicine,2024/11/12,低钠血症的临床意义中枢神经系统Beijing Hospita,目录,低钠血症的临床意义,低钠血症的诊断思路,低钠血症的治疗原则,Beijing Hospital of Traditional Chinese Medicine,2024/11/12,目录Beijing Hospital of Traditio,低钠血症的诊断思路,Beijing Hospital of Traditional Chinese Medicine,2024/11/12,低钠血症的诊断思路Beijing Hospital of T,低钠血症的诊断思路,血钠,135mmol/L,低钠血症,Beijing Hospital of Traditional Chinese Medicine,2024/11/12,低钠血症的诊断思路低钠血症Beijing Hospital,低钠血症的诊断思路,1.,血浆渗透压,2.,细胞外液状态,3.,尿钠（尿渗透压）,Beijing Hospital of Traditional Chinese Medicine,2024/11/12,低钠血症的诊断思路Beijing Hospital of T,低钠血症的诊断思路,1.,血浆渗透压,=,2,血钠（,mmol/L,）,+,血糖（,mmol/L,）,+,血尿素氮（,mmol/L,）,正常值：,270-290 mmol/L,高渗,移位性,低钠血症,等渗,假性,低钠血症,低渗,有意义,的低钠血症,Beijing Hospital of Traditional Chinese Medicine,2024/11/12,低钠血症的诊断思路1.血浆渗透压Beijing Hospit,低钠血症的诊断思路,高渗性低钠血症：钠以外的其他溶质导致血,浆渗透压升高,最为常见的原因：,高血糖；,血液中甘露醇浓度升高,Beijing Hospital of Traditional Chinese Medicine,2024/11/12,低钠血症的诊断思路Beijing Hospital of T,低钠血症的诊断思路,大量甘露醇充盈膀胱,血液中甘露醇水平显著升高,血液高渗状态,细胞内液向细胞外间隙移动,血钠水平降低,Beijing Hospital of Traditional Chinese Medicine,2024/11/12,低钠血症的诊断思路大量甘露醇充盈膀胱血液中甘露醇水平显著升高,低钠血症的诊断思路,等渗性：假性低钠血症。,最为常见的原因：,血浆中固相成分增加；,检测方法。,Beijing Hospital of Traditional Chinese Medicine,2024/11/12,低钠血症的诊断思路Beijing Hospital of T,低钠血症的诊断思路,血浆中固相成分增加,:,高血脂；,高蛋白血症,（多发性骨髓瘤；大量使用丙种球蛋白）；,Beijing Hospital of Traditional Chinese Medicine,2024/11/12,低钠血症的诊断思路Beijing Hospital of T,低钠血症的诊断思路,检测方法：间接离子特异性电极法,（特点：血液标本需要稀释后才能进行测定）,病例,A,患者,A,的,1ml,血浆中含：,930,l,水及,70,l,固体,水中,Na,+,=150mmol/L,固相,Na,+,=0mmol/L,采用,1,：,10,稀释的标本测定钠浓度,=1500.93/10=13.95mmol/L,血钠浓度,=13.9510=140mmol/L,病例,B,患者,B,的,1ml,血浆中含：,800,l,水及,200,l,固体,水中,Na,+,=150mmol/L,固相,Na,+,=0mmol/L,采用,1,：,10,稀释的标本测定钠浓度,=1500.8/10=12mmol/L,血钠浓度,=1210=120mmol/L,Beijing Hospital of Traditional Chinese Medicine,2024/11/12,低钠血症的诊断思路检测方法：间接离子特异性电极法病例A病例B,低钠血症的诊断思路,低渗性低钠血症：,2.,评估细胞外液状态：,低容量性（总水，总钠）；,等容量性（总水，总钠,-,）；,高容量性（总水，总钠）。,Beijing Hospital of Traditional Chinese Medicine,2024/11/12,低钠血症的诊断思路低渗性低钠血症：Beijing Hospi,低钠血症的诊断思路,细胞外液容量状态的判断：,Beijing Hospital of Traditional Chinese Medicine,2024/11/12,低钠血症的诊断思路细胞外液容量状态的判断：Beijing H,低钠血症的诊断思路,3.,测定尿钠水平：,判断钠丢失的途径（未使用利尿药物的情况下）：,尿钠,20mmol/L,肾脏排钠；,尿钠,20mmol/L,肾外途径,（胃肠道、第三间隙）。,Beijing Hospital of Traditional Chinese Medicine,2024/11/12,低钠血症的诊断思路Beijing Hospital of T,低钠血症的诊断思路,Beijing Hospital of Traditional Chinese Medicine,2024/11/12,低钠血症的诊断思路Beijing Hospital of T,