急性颈脊髓损伤后低钠血症的临床特点和发病机制

Clinical Features and Mechanism for Hyponatremia after Acute Cervical Spinal Cord Injury

目的:探讨急性颈脊髓损伤(ACSCI)后低钠血症的临床特点、诊断、治疗及发病机制。方法:对我院2003—2007年收治的ACSCI患者43例进行回顾性分析,按是否并发低钠血症,分为低钠组和对照组。对2组患者的体温、血压、心率、24h尿量、血钠、血钙、血氯和血钾指标、性别构成比、ACSCI平面和程度进行分析。结果:低钠组体温和24h尿量高于对照组(P<0.01),血压、心率、血钠、血钙和血氯低于对照组(P<0.05),在ACSCI平面和程度方面,2组之间差异有统计学意义(P<0.05),2组患者血钾水平和性别构成差异无统计学意义(P>0.05)。结论:ACSCI平面高、程度重易并发低钠血症,交感神经系统受抑制是ACSCI后低钠血症的发病机制之一。

Objective： To explore clinical features, diagnosis, therapy and mechanism of hyponatremia after acute cervical spinal cord injury （ACSCI）. Methods： From 2003 to 2007, 43 cases with ACSCI were respectively reviewed. According to whether hyponatremia happened or not, 43 cases with ACSCI were divided into illness group and control group. The clinical parameters of temperature, blood pressure, heart rate, urine volume of 24 hours, serum sodium, serum calcium, serum chlorine and serum potassium were analyzed with t-test, and the clinical parameters of sex, ACSCI plane and injury severity were analyzed with chi square test. Results： The temperature and urine volume of 24 hours in illness group were higher than those in control group. Blood pressure, heart rate, serum sodium, serum calcium and serum chlorine in illness group were lower than those in control group （P 〈 0.05）. ACSCI plane and injury severity in two groups have statistical difference, and the serum potassium and sex in two groups have no statistical difference. Conclusion： The higher ACSCI plane and severity of injury is, the more possibility the onset of hyponatremia is. The inhibition of sympathetic preganglionic neurons is one of the mechanisms for hyponatremia after ACSCI.