重度烧伤后高钠血症的诊治进展

doi:10.6040/j.issn.1671-7554.0.2026.0773

摘要/Abstract

摘要： 高钠血症是重度烧伤患者常见且严重的电解质紊乱,其发生率显著高于普通重症人群,并与死亡率升高、住院时间延长以及创面愈合不良密切相关。论文系统总结重度烧伤后高钠血症的最新研究进展,并重点阐述其病因、病理生理机制、临床表现、诊断策略以及治疗方案。其核心病理生理改变涉及皮肤屏障破坏、神经内分泌轴激活和全身炎症反应等;病因以自由水缺乏、钠负荷过量和继发感染为主;临床上突出表现在神经系统症状,常伴随多器官功能障碍;诊断需以血清钠动态监测为核心,规范完成假性高钠血症排除、血糖校正以及病因鉴别流程;在治疗方面,强调个体化液体管理,明确急慢性高钠血症的纠正速度,同时重视早期创面处理、感染控制和器官支持,对顽固性高钠血症,建议采用区域枸橼酸抗凝连续性肾脏替代治疗,以实现精准降钠。论文旨在为临床医师提供有关重度烧伤后高钠血症的最新诊治参考,并指明未来研究的潜在方向。

关键词: 烧伤, 高钠血症, 个体化液体管理, 连续性肾脏替代治疗, 脓毒症

Abstract: Hypernatremia is a common and severe electrolyte disorder in patients with major burns, with an incidence significantly higher than that in the general intensive care unit population, and it is closely associated with increased mortality, prolonged hospital stay, and impaired wound healing. This article systematically summarized the latest research advances in hypernatremia after major burns, with a focus on its etiology, pathophysiological mechanisms, clinical manifestations, diagnostic strategies, and treatment regimens. Its core pathophysiological alterations involve disruption of the skin barrier, activation of the neuroendocrine axis, and systemic inflammatory response. The main etiologies include free water deficit, excessive sodium load, and secondary infection. Clinically, it predominantly presents with neurological symptoms and is frequently accompanied by multiple organ dysfunction. Diagnosis should be centered on dynamic monitoring of serum sodium, with standardized exclusion of pseudohypernatremia, correction of blood glucose, and etiological differential diagnosis. In terms of treatment, individualized fluid management is emphasized, and the correction rate for acute and chronic hypernatremia must be clearly defined. Meanwhile, early wound management, infection control, and organ support should be prioritized. For refractory hypernatremia, continuous renal replacement therapy with regional citrate anticoagulation is recommended to achieve precise sodium reduction. This article aims to provide clinicians with the latest reference for the diagnosis and treatment of hypernatremia after major burns and points out potential directions for future research.

Key words: Burns, Hypernatremia, Individualized fluid management, Continuous renal replacement therapy, Sepsis

中图分类号:

R644

杨红坤,李天鑫,范春节,张灿勇,黄俊,黄国宝. 重度烧伤后高钠血症的诊治进展[J]. 山东大学学报 (医学版), 2026, 64(9): 111-117.

YANG Hongkun, LI Tianxin, FAN Chunjie, ZHANG Canyong, HUANG Jun, HUANG Guobao. Advances in diagnosis and management of hypernatremia after severe burns[J]. Journal of Shandong University (Health Sciences), 2026, 64(9): 111-117.

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