急性脊柱脊髓损伤患者低钠血症的临床表现

Clinical character of hyponatremia after actue spinal cord injury

目的探讨急性脊柱脊髓损伤患者低钠血症的临床发病情况、发生机制和治疗措施。方法对 99例急性脊柱脊髓损伤后发生低钠血症患者的临床资料做回顾性分析。结果患者的临床表现可分为 3类 :第一类胸腰脊髓损伤患者占多数 ,平均最低血钠 (12 8 6± 6 6)mmol/L ,平均低钠持续时间 (8± 5 3)天 ,经积极补钠和 /或适当限水 ,患者的血钠水平多在两周内恢复并稳定在正常水平 ;第二类全部为颈脊髓损伤患者 ,平均最低血钠 (12 5 1± 6 0 )mmol/L ,持续时间平均 (2 6 7± 17 0 )天 ,尿钠 2 0 0mmol/2 4h ,补钠效果较差 ;第三类全部为颈脊髓损伤患者 ,平均最低血钠 (118 3± 9 4)mmol/L ,低钠血症持续时间平均 (36 8± 5 4)天 ,尿钠2 0 0— 40 0mmol/2 4h ,持续 4周以上尿量超过 40 0 0ml,补钠可使血钠进一步下降 ,限水治疗有效。

ObjectiveTo define the occurrence rate,time course, potential etiologic factors, treatment and prognosis of hyponatremia in patients with actue spinal cord injury.Methods99 patients who were admitted with hyponatremia after acute spinal cord injury were analysed retrospectively. ResultsAll these patients could concluded into three types:type I were mostly the patients with thoracic and lumbar spinal cord injury,whose mean lowest serum natrium concentration (MLSNC) were (128.6±6.6)mmol/L,continued (8±5.3)days,and it could be recovered after two weeks by accurate supply natrium and/or fluid restriction.Type II included the patients with cervical spinal cord injury,whose MLSNC were(125.1±6.0)mmol/L, continued(26.7±17.0)days,mean uric natrium concentration were 200mmol/24h,and poorly responded to the therapy of supply natrium.Type III also included the patients with cervical spinal cord injury, whose MLSNC were (118.3±9.4)mmol/L, continued (36.8±5.4)days, uric natrium concentration were 200-400mmol/24h, urinary volume had been above to 4000ml for 4 weeks.The serum natrium concentration would decrease after supply natrium therapy,but would recover.after fluid restriction. ConclusionsThe hyponatremia in patients with actue spinal cord injury sould be treated according to different type.