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对低钠血症(hyponatraemia)的治疗,因有引起桥脑中心型髓鞘脱失症(CPM)或桥脑外周型髓鞘脱失症(extrapontine myelimolysis EPM)的危险而存在争议。有人提议用高张盐液快速纠正低血钠,也有人认为应缓慢纠正,大多数同意应避免过度纠正低血钠。本文作者报道了三例低钠血症患者,一例用等张盐液缓慢纠正低血钠,一例用高张盐液快速纠正。一例用高张液过度纠正。三例均进展至昏迷而死亡,均有EPM或(和)CPM。作者结合文献复习对低钠血症的各种治疗建议和髓鞘脱失的可能发病机制作了论述。 CPM由Adams等1959年首次报道,EPM于
The treatment of hyponatraemia is controversial because of the risk of causing pontine central demyelinating disorder (CPM) or extrapontine myelimolysis EPM. It has been suggested that hypertonic saline should be used to quickly correct hyponatremia, while others believe it should be slowly corrected, and most agree that over-correction of hyponatremia should be avoided. The authors reported three patients with hyponatremia, one with a slow correction of hyponatremia with isotonic saline, and one with rapid correction using hypertonic saline. A case of over-correction with high-tension fluid. All three cases progressed to coma and died, both with EPM or (and) CPM. The authors reviewed the literature review of various treatment recommendations for hyponatremia and possible pathogenesis of myelinolysis. CPM was first reported by Adams et al in 1959, EPM