急性颈髓损伤并发抗利尿激素分泌异常综合征

Syndrome of inappropriate antidiuratic hormone secretion caused by acute cervical spinal cord injury

抗利尿激素分泌异常综合征（ＳＩＡＤＨ）是急性颈髓损伤的严重并发症，如治疗不当，则低血钠症难以纠正，而且可加重神经系统损害或使已恢复的神经功能再次消失。本组９例中，３例病人因误诊而大量补充等张盐水纠正低血钠症，其中１例死亡，２例恢复缓慢，其余６例病人确诊ＳＩＡＤＨ后，治疗得当，恢复良好。作者就９例急性颈髓损伤合并ＳＩＡＤＨ病人的发病机理、诊断和治疗进行讨论。认为：（１）在颈椎颈髓损伤时视丘下部轻微损伤或受刺激使ＡＤＨ分泌增加；（２）颈髓损伤病人植物神经功能调节障碍，有效血容量减低，经压力感受器的神经调节机制使垂体后叶分泌增加是急性颈髓损伤病人合并ＳＩＡＤＨ的主要原因。个别病人可因呼吸机辅助呼吸和使用双氢克尿噻诱发ＳＩＡＤＨ；（３）颈髓损伤病人出现低血钠时，应严密监视有关数值的变化，警惕ＳＩＡＤＨ的发生；（４）颈髓损伤病人合并ＳＩＡＤＨ的治疗原则仍是严格控制水摄入量、适量补盐，将血钠控制在安全水平（１２５ｍｍｏｌ／Ｌ）以上。

The diagnosis and treatment of 9 patients with syndrome of inappropriate antidiuratic hormone secretion caused by acute cervical spinal cord injury without functional disturbance of cardiac,renal,pulmonary,thyroid and adrenal glands are described. SIADH is characterized by hyponatremia, hyposmolality of plasma and impaired dilution of urine. It is a critical complication for the cervical spinal cord injured patients. The hyponatremia would be corrected,if SIADH could be recognized and treated in time and properly. Otherwise,the nervous system would be damaged and even the recovered functions of nervous system would lose again. Because of misdiagnose,three patients in this group were given normal saline to correct hypontremia. One of them died,the other two recovered rather slowly. The rest (6 patients) in the group were gotten correctly diagnosis and properly treatment. They recovered well as expected. The etiology were also discussed. Following reasons for this complication occurred in those patients could be considered : (1)The hypothalamus was mild damaged or stimulated as the cervical spinal cord was injured. (2)The decrease of the effective circulatory blood volume and then the stimulation of pressure-sensitive atrial and arterial receptors responded for the damage of the autonamic nervous system. Consequently,ADH secretion increased through the reflex regulation. (3)When hyponatremia occurred to the patients with cervical spinal cord injury,relevant values should be carefully controlled to watch out the happening of SIADH. (4)The concept of the treatment was the critical restriction of water-intake,proper infusion of sodium chloride and controlling of sodium level in blood(>125mmol/L).Autbor's address The Department of Spine and Spinal Cord Surgery,The China Rehabilitation Research Center,Beijing, 100077