急性颈髓损伤后低钠血症15例报告及文献复习

Hyponatremia after acute cervical spinal cord injury: clinical study on 15 cases

目的探讨急性颈髓损伤后低钠血症的病因、发病机制、诊断和治疗。方法回顾性分析2000年～2004年收治的急性颈髓损伤后低钠血症患者15例的临床资料。结果全组患者入院24～72h内血钠低于130mmol/L,其中5例低于120mmol/L。14例尿钠40～68mmol/L,1例尿钠为148mmol/L;尿渗透压420～980mmol/L。12例患者经适当的补盐和限制水摄入量治疗,低钠症状2～3周内改善;2例发热患者因发热不能严格限制水摄入,其中1例2个月后恢复,另1例失访;1例患者补盐限水后病情加重,调整治疗方案后恢复。结论颈髓损伤越重,损伤后低钠血症发生率越高;颈髓损伤后低钠血症多由抗利尿激素分泌异常综合征引起;血钠浓度,血、尿渗透压等是诊断依据;适当补充钠盐和液体量是有效的治疗方法。

Objective To investingate the pathogenesis,pathology,diagnosis and therapy of hyponatremia after acute spinal cord injury.?Methods 15 in-patients with hyponatremia after acute spinal cord injury from 2000 to 2004 were retrospectively analyzed.?Results Serum sodium was lower than 130 mmol/L in all cases. Urine sodium ranged from 40 to 68 mmol/L and urine osmotic pressure ranged from 420 to 980 mmol/L.After limitation of water intake and appropriate salt intake,12 patiants recovered after 2 to 3 weeks.Because of fever and avoiding limitation of water intake, the other 3 patiants recovered slowly.?Conclusion The more serious the acute spinal cord injury,the higher the frequency of hyponatremia; syndrome of inappropriate antidiuretic hormone secretion (SIADH) is its primary cause;appropriate measures should be taken to correct the hyponatremia according to the findings of serum sodium and urine osmotic pressure.