急性颈脊髓损伤后低蛋白血症的病因和防治

Prevention & treatment and pathogenesis discussion of hypoproteinemia after acute cervical spinal cord injury

目的分析急性颈脊髓损伤（acutecervicalspinalcordinjury，ACSCI）后低蛋白血症（hypoproteinemia）的发生机制，探讨其临床特点，以及预防与治疗低蛋白血症的有效方法。方法回顾总结分析了2012年6月-2014年3月济南军区总医院脊髓修复科145例ACSCI患者的发生低蛋白血症的临床特点。将纳入病例分为老年组（≥60岁）65例，中青年组（〈60岁）80例两组；肺部感染气管切开组（80例）、无肺部感染气管未切开组（65例）；完全性损伤组110例、不完全损伤组35例；C2～C3组20例，C4～C5组85例；C6～C7组40例，其中气管切开组与未切开组行以下检测：每3d抽血复查肝肾功等必要指标，分析两组患者人院后患者的血清白蛋白的变化趋势，以及何时给予患者静脉输注白蛋白最为有效，人院后均给予静脉滴注白蛋白及肠内营养，并鼓励患者尽早行自主进食。应用SPSSl5．0软件进行统计学分析，t检验进行组间和组内比较，P〈O．05时差异有统计学意义。结果入院时各组间差异无统计学意义（P〉O．05）。C4～C5节段的颈脊髓损伤发生低蛋白血症的概率要明显高于其他节段；完全性颈脊髓损伤发生低蛋白血症的概率要远远高于不完全颈脊髓损伤。肺部感染是诱发低蛋白血症的一个重要因素。入院前18d，两组间差异有统计学意义（P〈0．05）。两组白蛋白指标变化趋势大致相同。结论急性颈脊髓损伤后血清白蛋白迅速降低，临床中治疗纠正困难，治疗中的激素冲击治疗、并发的感染等诸多因素均可加重低蛋白血症：颈脊髓损伤导致的低蛋白血症而无法进食的患者应立即给予营养支持及静脉滴注足量的人血白蛋白．可有效降低低蛋白血症的发生，肺部感染会加重低蛋白血症。

Objective To analyse hypoalbuminemia （Hypoproteinemia） mechanism following acute cervical spinal cord injury（acute cervical spinal cord injury,ACSCI）,and to discuss its clinical features,as well as effective prevention and treatment methods. Methods The changes in the characteristics of 145 cases of spinal cord repair ACSCI patient＇s blood albumin from June 2012 to March 2014 in the General Hospital of Jinan military region. The older group included 65 patients grouped into（〉~60 years old） the young group （〈60 years,80 cases） ;lung infection tracheotomy group （80 cases）,no lung infection trachea uncut group （65 cases）;ll0 cases were of completely injury group,35 patients incomplete injury;C2-C3 group of 20 cases,C4-C5 group of 85 cases ;C6-C7 group of 40 cases who underwent the following tests：after admission were given with intravenous albumin and intestinal nutrition as early as possible and were encouraged self-feeding,blood was sampled every three days to be reexamination such as liver and kidney function indicators so as to analyze their serum albumin trends and to judge when to give the patient an intravenous infusion of albumin most effectively. SPSS15.0 software was applied for statistical analysis,t test was used in comparison inter- and intra- groups,P〈0.05 when the difference was statistically significant. Results Differences of inter- groups was not statistically significant at admission（P〉0.05）. In cervical spinal cord C4-C5 segments injury the incidence of low protein was significantly higher than other segments;in complete cervical spinal cord injury hypoproteinemia possibility was much higher than the incomplete cervical spinal cord injury. Lung infection inducing hypoalbuminemia was an important factor. 18 d,before admission,there were significant differences between both groups （P〈0.05）. Both＇s albumin index roughly was of the same trend. Conclusion Serum albumin after acute cervical spinal cord injury decreases rapidly,clinical treatment to correct it is of the diffficuhies;the impact of hormone therapy in the treatment of concurrent infections,and many other factors can all aggravate hypoalbuminemia;the patients with low protein induced by cervical spinal cord injury who can not eat immediately are given timely and adequately amounts of nutritional support as well as human serum albumin infusion which could effectively reduce the incidence of hypoal- buminemia;lung infections could aggravete hypoproteinemia.