急性颈髓损伤后低钠血症的发病机制和治疗

Pathogenesis and Treatment of Hyponatremia after Acute Cervical Spinal Cord Injury

目的：探讨急性脊髓损伤后低钠血症的发病机制和治疗方法。方法：回顾性分析了2007年8月-2011年7月共收治急性脊髓损伤患者45例,排除肾病,糖尿病以及合并颅脑损伤后共37例（其中完全性损伤8例,不完全性损伤29例）。以入院后常规血生化检查,复查两次血钠小于130mmol/L和24h尿量记录大于3000ml者为标准,随机分A组27例依照颅脑外伤后低体液容量型低钠血症（CSWS）治疗方法给予纠正补钠；B组10例依照颅脑外伤后抗利尿激素分泌异常综合征（SIADH）治疗方法给予限水补钠。结果：A组26例经7-12天（平均8.2天）治疗血钠平均恢复至138（135-142）mmol/l,1例自动要求出院；B组8例经12-21天（平均12.4天）治疗血钠平均恢复至136（135-138）mmol/l,2例自动要求出院。结论：低钠血症是急性颈脊髓损伤常见的并发症,经回顾分析其发生机制,临床上主要为脑盐耗综合征（CSWS）,所以在治疗急性脊髓损伤患者并发低钠血症时,可按照低体液容量型低钠血症进行及时治疗。

Objective： To analyze correlation factors and its treatment of hyponatremia in acute cervical spinal cord injury. Methods：A retrospective analysis of August 2007-2011 July a total acute spinal cord injury patients in 49 cases, eliminate kidney disease, diabetes and merge after craniocerebral injury 37 cases （including completeness damage 15 cases, incomplete damage 32 cases）. With routine blood biochemical examination after admission, review twice 130mmol serum sodium less than 24h urine output/L and recorded more than 3000ml person for standard, Random points in group A 27 cases in accordance with craniocerebral trauma low humoral capacity type hyponatremia （CSWS） treatment give correct fill sodium, Group B in accordance with craniocerebral trauma after 10 cases of vasopressin secretion abnormal syndrome （SIADH） treatment given limited water filling sodium. Results：Group A 26 cases by 7-12 days （on average 8.2days） treatment serum sodium average recovery 138 （135-142 mmol/l） and 1 case of automatic request discharge from the hospital, Group B 8 cases by 12-21 days （mean 12.4 days） treatment serum sodium average recovery 136（135-138mmol/l）, 2 cases of automatic request discharge from the hospital. Conclusion：Hyponatremia is acute cervical spinal cord injury, the common complication of retrospectively analyzed its pathogenesis, clinical mainly for brain salt wasting syndrome （CSWS）, so in the treatment of acute spinal cord injury patients developed hyponatremia, can according to low humoral capacity type hyponatremia timely treatment.