急性完全性颈髓损伤并发低钠血症的早期有效防治

Effective prophylaxis of hyponatremia after acute cervical spinal cord injury

目的探讨急性完全性颈髓损伤后并发低钠血症的有效预防与治疗。方法采用前瞻性方法,选择自2013-01—2015-05诊治的急性完全性颈髓损伤81例,入院后随机分为2组,A组40例入院后根据体重（以kg为单位）每日需钠量立即给予1/3~1/2量口服补钠,发现低钠血症后给予静脉补钠,以30 ml/h的速度静脉滴注,并根据尿量限制液体入量。B组41例入院后不口服补钠,在发现低钠血症后再行静脉补钠。结果 42例（51.9%）发生低钠血症,其中A组15例（37.5%）,B组27例（65.9%）;A组低钠血症发生率明显低于B组,差异有统计学意义（χ2=6.520,P=0.011）。发生低钠血症时间距伤后3~15 d,平均9 d;低钠血症持续时间11~25 d,平均18 d。A组意识障碍发生率（χ2=4.419,P=0.036）、血氧饱和度降低发生率（χ2=4.125,P=0.042）、非心源性肺水肿水泡痰发生率（χ2=5.239,P=0.022）明显低于B组,差异有统计学意义（P〈0.05）。结论急性完全性颈髓损伤可并发严重低钠血症,在颈髓损伤后早期采取预防性干预措施,早期发现及时纠正低钠血症对于改善预后具有极其重要的意义。

Objective To investigate the effective method for prevention of hyponatremia after acute cervical spinal cord injury（ACSCI）. Methods In randomized prospective trials, 81 patients with acute spinal cord injury（ASCI） from Jan. 2013 to May 2015 were divided into 2 groups at random. Group A（40 cases）： oral 1/2-1/3 daily need magnitude of natrium muriaticum was given immediately after hospitalization, according to each case weight（kg）. When hyponatremia was detected, intravenous sodium were given（30 ml/h）. Group B（41 cases）： no oral natrium muriaticum were given after hospitalization. While hyponatremia was detected, intravenous sodium were given. Input was constrained according to daily urine volume. Results Forty-two cases were found hyponatremia（59.1%）, among which 15 patients were found in group A（37.5%）, 27 cases in group B（65.9%）. The rate of hyponatremia in group A was significantly lower than that in group B（χ2=6.520, P =0.011）. Hyponatremia appeared 3-15 d（the mean time was 9 d） after trauma. The time of duration was 11-25 d（the mean time was 18 d）. The rate of disturbance of consciousness（χ2=4.419, P =0.036）, oxygen saturation（χ2=4.125, P =0.042）, non cardiogenic pulmonary edema（χ2=5.239, P =0.022） in group A were significantly lower than those in group B. The difference were significantly（ P〈0.05）.Conclusion ACSCI may cause severe hyponatremia. Initiative prevention and early intervention soon after SCI as well as early detection of hyponatremia can effectively improve the prognosis.