颈髓损伤后低钠血症的诊断要点及治疗

Diagnosis and Treatment for Hyponatremia after Cervical Spinal Cord Injury

目的探讨颈髓损伤并发低钠血症的危险因素及低钠血症的分类诊治效果.方法将收治的126例颈髓损伤患者按是否并发低钠血症,分为发病组和未发病组,对两组的临床资料包括:性别、年龄、损伤程度(Frankel分级)、是否合并颅脑损伤、肺部感染、使用脱水剂进行统计和Logistic回归分析.根据临床表现和血清钠、尿钠、尿比重等实验室指标确定低钠血症的类型,对脑性耗盐综合征采取补钠、补水原则进行治疗;对抗利尿激素分泌异常综合征采取限制液体入量的原则进行治疗.结果Logistic回归分析显示:低钠血症的发生与颈髓损伤程度(A级)、颅脑损伤及肺部感染的相关系数(r)分别为0.566、0.634、0.587(P均<0.05);与脱水剂治疗相关系数r=0.566(P>0.05).低钠血症组107例患者在监测中心静脉压及24h尿钠的前提下适量补液和补钠或限制输液量,血清钠1～3周内逐步恢复正常,临床症状明显改善.结论颈髓损伤后低钠血症的发生与颈髓损伤程度、是否合并颅脑损伤及肺部感染有关,对低钠血症的类型进行鉴别诊断并进行相应处理是必要和有效的。

Objective To explore the risk factors related to hyponatremia resulted from cervical spinal cord injury and the treatment outcomes of hyponatremia according to its classification. Methods According to whether complicated by hyponatremia, 126 patients with cervical spinal cord injury were divided into two groups, illness group and no illness group. Their clinical data including gender, age, injury extent （ Frankel Classification）, associated head injury, pulmonary infection, using of dehydrolyzing agent were added up and analyzed by Logistic regression analysis. The types of hyponatremia were defined according to clinical manifestations, sodium concentration in serum, sodium concentration in urine and urine specific gravity. Cerebral salt wasting syndrome （CSWS） was treated abiding by the principle of fluid and sodium replacement while syndrome of inappropriate antidiuretic hormone （SIADH） was treated abiding by the principle of limitation of water intake and adding salt. Results Logistic regression analysis showed the coefficient correlationr between hyponatremia and Frankel A classification, head injury, pulmonary infection were 0. 566, 0. 634, 0. 587 respectively （P 〈 0. 05）. It was also showed the coefficient correlation （r） between hyponatremia and using of dehydrolyzing agent was 0. 566 （P 〉 0. 05）. Under the conditions of CVP and sodium concentration in urine monitoring, the sodium concentration in serum recovered to normal within 1 -3w through modest fluid and sodium replacemen or after sufficient quantum fluid replacement and limitation of water intake and adding salt and their clinical manifestations relieved. Conclusions The risk factors related to hyponatremia resulted from cervical spinal cord injury included Frankel A classification, head injury, pulmonary infection. It is essential and effective that hyponatremia resulted from cervical spinal cord injury should be treated differently according to different types.