Abstract:Objective: To analyze the risk factors of penetrating demyelinating syndrome after severe traumatic brain injury, and to provide reference for clinical prevention and treatment. Methods: Retrospective analysis of clinical data from March 2011 to March 2016 in our hospital of 450 cases of severe craniocerebral trauma patients, according to whether the occurrence of osmotic demyelination syndrome (ODS) were divided into ODS group and non ODS group, compared two groups of patients with gender, age, admission damage degree (GCS score), associated injuries, cerebral contusion and the brain, skull fracture, hypotension, traumatic subarachnoid hemorrhage, hematoma, difference of mannitol dosage index. Results: 450 cases of patients with severe traumatic brain injury in the occurrence of osmotic demyelination syndrome in 11 cases, the incidence rate of 2.44%; Single factor analysis showed that the age of the ODS group was significantly higher than the control group, severe injury, injury, hypotension, cerebral hernia, brain contusion, hematoma was significantly higher than non ODS group (t=9.584, χ2=4.877~9.584, P<0.05); Multi Logistic regression analysis showed that age, GCS score (3-8), cerebral contusion, hematoma clearance, hypotension for severe brain tallage risk factors after osmotic demyelination syndrome (β=0.032~0.754, S.E= 0.007~0.302, Wald = 5.324~28.302, P<0.05). Conclusion: The osmotic demyelination syndrome with age and severity of injury, injury type and other factors related to severe traumatic brain injury, we should strengthen the prevention of risk factors, reduce the incidence of osmotic demyelination syndrome.
[1]Tzoulis P, Wanung JA, Bagkeris E, et al. Real-life experience of tolvaptan use in the treatment of severe hyponatraemia due to syndrome of inappropriate antidiuretic hormone secretion[J].Clin Endocrinol,(Oxf),2016,84(4):620~626. [2] 姚本海,刘娇,徐忠祥.垂体后叶素相关渗透性脱髓鞘综合征一例报道及文献复习[J].中华神经医学杂志,2015,14(11):1168~1169. [3] 周金方,贡伟一,张曙光,等.颅脑外伤后低钠血症与血清脑钠素抗利尿激素醛固酮的关系[J].中国实用神经疾病杂志,2015,18(2):47~49. [4] Siegler JE, Wang AR, Vanderwerf JD. Normonatremic osmotic demyelination in the setting of acquired immune deficiency syndrome and malnutrition: case report and literature review[J].Neurovirol,2016,22(6):876~879. [5] 郑海军,娄晓辉,杨洪军,等.无中线移位的重型颅脑外伤急性弥漫性脑肿胀的危险因素分析及手术治疗策略[J].浙江创伤外科,2014,19(01):57~59. [6] Martin RJ. Central pontine and extrapontine myelinolysis: theosmotic demyelination syndromes[J].Neurol Neurosurg Psychiatry,2004,75(suppl 3):22~28. [7] Canaday S, Rompala J, Rowles J, et al. Chronic severe hyponatremia and cardiopulmonary bypass: avoiding osmotic demyelination syndrome[J].Extra Corpor Technol,2015,47(4):228~230. [8] 游志清,郎红梅,刘君静,等.垂体功能减退症并渗透性脱髓鞘综合征2例报告并文献复习[J].国际内分泌代谢杂志,2014,34(02):141~143. [9] 江川.钠代谢诶对重型颅脑损伤患者病情及预后评价临床应用研究[J].河北医学,2016,22(1):102~105. [10] Meng X, Shi B. Traumatic brain injury patients with a glasgow coma scale score of ≤8, cerebral edema, and/or a basal skull fracture are more susceptible to developing hyponatremia[J].Neurosurg Anesthesiol,2016,28(1):21~26. [11] 李海蒙,赵耀东,侯典琦,等.中-重型颅脑损伤患者血钠异常与损伤类型的相关性研究[J].海南医学,2016,27(5):805~807. [12] 郭利娜,谭贤佩,杨杰,等.去氨加压素致低钠血症后引起的渗透性脱髓鞘综合征[J].中风与神经疾病杂志,2013,30(11):1037~1038. [13] Xu DH, Yuan M, Wang JW, et al. Osmotic demyelination syndrome after correction of severe hyponatremia associated with pituitrin[J].Int Clin Pharmacol Ther, 2015, 53(5):408~411. [14] 陈忠.围术期血清钠离子水平对重型颅脑损伤患者病情及预后的影响[J].中国实用神经疾病杂志,2015,18(20):5~6. [15] Craziani G, Cucchiari D, Aroldi A, et al. Syndrome of inappropriate secretion of antidiuretic hormone in traumatic brain injury: when tolvaptan becomes a life saving drug[J].Neurol Neurosurg Psychiatry,2012,83(5):510~512.