低钠血症、多尿症与颈髓损伤

Hyponatremia and polyuria with injury of marrow in neck

目的探讨颈髓损伤后出现多尿症、低钠血症的机理及治疗方法。方法对1例强直性脊柱炎颈髓损伤并多尿症的原因进行分析并结合文献复习进行讨论。结果病人存在尿崩,且为肾性。多尿原因之一为伤前就存在的肾性尿崩,其二是颈髓损伤所致的交感神经功能紊乱;多尿症及低钠血症是颈髓损伤后常见并发症。结论颈髓损伤后发生的低钠血症存在两种理论解释,一是抗利尿激素分泌异常综合症(SIADHS),一是脑盐耗综合征(CSWS)。多尿症同样有两种解释,一为颈髓损伤所致的交感神经抑制,再就是颈髓损伤同时颅内损害所致的中枢性尿崩。确切发病机理尚有待于进一步研究与明确。

Objective To study the mechanism and the therapeutic method of hyponatremia and polyuria after injury in marrow of neck. Methods The cause of polyuria coming forth after a ease of ankylosing spendylitis （AS） is injured in marrow of neck is analyzed and the literature is reviewed. Results Diabetes, insipidus exists and it is renal one, The reason of diuresis has two, One is renal diabetes insipidus existing before injury and the another is disorder of sympathetic nerve coming from the injury of marrow of neck; Hypenatremia and polynria are common complication after injury of marrow in neck. Conclusion The mechanism of hyponatremia after injury of marrow in neck has two： One is syndrome of inappropriate ADH secretion （SIADHS） and another is cerebral salt-wasting syndrome （CSWS）, Polyuria has two explainment also. The first is suppression of sympathetic nerve because of injury of marrow in neck and the second is central diabetes insipidus coming from cerebral damage taking place in neck at the same time, The definite mechanism need to be investigated furtherly.