急性颈脊髓损伤并发低钠血症

Hyponatremia after acute cervical spinal cord injury.

目的探讨急性颈脊髓损伤并发低钠血症的发病机制和治疗方法。方法分析急性颈脊髓损伤31例中15例出现低钠血症并多尿。4例轻度缺钠（血钠130～134mmol/L）,未做特殊处理;3例中度缺钠（血钠125～129mmol/L）,补充等渗盐水和高盐饮食;8例重度缺钠（血钠〈125mmol/L）：静脉补钠,其中3例血浆渗透压低、中心静脉压高的患者限水治疗;5例血浆渗透压改变不明显而中心静脉压低的患者补充容量。结果轻中度患者血钠和尿量很快恢复正常;6例重度患者血钠和尿量恢复正常,最短恢复时间18d,最长时间39d。2例好转,血钠和尿量到出院时仍未达正常水平。结论颈脊髓损伤并发低钠血症可能与脑性盐耗综合征（CSWS）或抗利尿激素不适当分泌综合征（SIADH）有关。重度缺钠较顽固,治疗时应鉴别是高容量型（SIADH）或容量不足（CSWS）。高容量型限水治疗,严重缺钠应静脉补钠;容量不足以容量替代和保持正盐平衡为主。

Objective To investigate the pathogenesis and treatment methods of hyponatremia after acute cervical spinal cord injury.Methods Retrospective analysis of 15 cases of acute cervical spinal cord injury with hyponatremia and polyuria among 31 cases.Four cases of mild（serum sodium 130-134 mmol/L）were not treated specially;and 3 cases of moderate（serum sodium 125-129 mmol/L） were treated with 0.9% natrium chloride and high-salt diet.Eight cases of severe（serum sodium〈125mmol/L） were treated with 3% natrium chloride vena drip,and among them 3 cases with low plasma osmolality and high central venous pressure were restricted water intake;5 cases with low central venous pressure were added fluid.Results The serum sodium and urine quickly returned to normal in patients with mild to moderate;Six cases with severe hyponatremia resumed normal serum sodium and urine,the shortest recovery time was 18 days and the longest 39 days.Two cases improved,but serum sodium and urine had yet not been reached normal level until discharged.Conclusion Cervical spinal cord injury with hyponatremia may be the cerebral salt wasting syndrome（CSWS） or the syndrome of inappropriate secretion of antidiuretic hormone（SIADH）.The treatment should be distinguished a high-capacity type（SIADH）or inadequate capacity（CSWS）.SIADH was treated by restricted water intake and proper infusion sodium chloride while CSWS was treated by adding fluid and sodium.