急性颈脊髓损伤低蛋白血症的临床特点及治疗

Clinical characteristics and effective treatment for hypoproteinemia after acute cervical spinal cord injury

目的探讨急性颈脊髓损伤低蛋白血症的临床特点及有效治疗措施。方法回顾性分析2004年9月～2012年1月收治的335例急性颈脊髓损伤患者,其中未行气管切开187例(A组),行气管切开148例(B组)。分析患者入院至出院前白蛋白指标的变化特点。患者入院后即采用静脉三升袋营养配合胃管鼻饲,每周行2次白蛋白检测,根据所测指标调整营养成份及剂量,对于A组伴有呼吸机辅助呼吸的患者,可同时以人血白蛋白静滴,能自主进食鼓励加强饮食;加强抗感染及水电解质平衡治疗。对比分析2组白蛋白变化趋势及在入院时、入院后每3 d的血清白蛋白含量;对2组白蛋白指标差异及白蛋白静滴例数对比进行统计分析。结果入院时2组间差异无统计学意义(P>0.05)。A组白蛋白最低在入院后12 d,为(31.8±3.7)g/L;B组白蛋白最低在入院后9 d,为(29.8±3.2)g/L。入院前18 d,2组间差异有统计学意义(P<0.05)。2组白蛋白指标变化趋势大致相同;B组静滴白蛋白例数明显多于A组,2组间差异有统计学意义(P<0.05)。结论急性颈椎脊髓损伤后血清白蛋白迅速降低,纠正困难,气管切开加重低蛋白血症;采用静脉三升袋营养配合胃管鼻饲,鼓励自主进食,必要时静滴人血白蛋白静滴,是有效治疗方法。

Objective To explore the clinical characteristics and early effective treatment for hypoproteinemia after acute cervical spinal cord injury. Methods A total of 335 patients with acute cervical spinal cord injury were analyzed retrospec- tively, including 187 patients without tracheotomy （Group A） and 148 ones with traeheotomy（ Group B）. When the patients were in hospital, the serum albumin were analyzed every 3 d before discharge. Three litre bag and nasal feeding were used to improve the nutrition condition and the nutrition constituent was regulated by the blood analysis. The human serum albumin was infused by vein for the patients with incision of trachea and breath machine. The patients were encourged to eat by them- selves and to strengthen anti-infection therapy and regulate the water-electrolyte balance. The SPSS 15.0 was used to contrast the difference of serum albumin between the 2 groups. Results There was no significant difference for serum albumin between the 2 groups on admission. The lowest serum albumin for Group A was （31.8± 3.7 ） g/L in the 12th day. The lowest serum albumin for Group B was （29.8±3.2） g/L in the 9th day. However, there was significant difference for serum albu- min between the 2 groups during 18 days after admission （P 〈0.05）. There was similar change of serum albumin between the 2 groups. There was more patients who need human serum albumin infuse by vein in Group B than the ones in Group A and there was significant difference （P 〈 0.05）. Conclusion Serum albumin decreases rapidly and hypoproteinemia can be trea- ted difficultly for acute cervical spinal cord injury. The incision of trachea aggravates hypoproteinemia. Three litre bag and nasal feeding, encouraging eating by himself and human serum albumin infusing by vein are effective therapies.