颈髓损伤后低钠血症临床分析.docVIP

颈髓损伤后低钠血症临床分析 李诚△，陈晓△，乔苏迟，刘畅，朱德刚，吾不力·阿扎提 【摘要】 目的 探讨急性颈髓损伤后低钠血症的临床特点以及治疗方法。方法 2008年5月至2013年12月间我院收治外伤性髓损伤病人251人，其中诊断为低钠血症的患者有149例。对其进行临床特点、治疗方法及结果进行回顾性分析。结果 低钠血症组与血钠正常组在年龄、损伤平面、有无脑外伤、有无合并感染、神经损伤程度具有显著差异，在性别上无显著差异。149例低钠血症病人中12例诊断为肾外钠丢失，死亡5人；其余为中枢性低钠（CSWS 91例，SIADH 40例）其中116例低钠血症得以纠正；另外6例患者由于临床特点特殊导致判断错误，其中2例因进行性低钠血症死亡。结论 颈髓损伤后低钠血症主要发病机制为脑性盐耗综合征(CSWS) 和抗利尿激素分泌异常综合征(SIADH)两种，两种机制容易混淆，治疗方法完全相反，治疗时需密切观察患者血钠、症状、尿量、CVP、血尿渗透压变化综合判断以决定治疗方案。 【关键词】脑性盐耗综合征抗利尿激素分泌异常综合征 Clinical analysis of hyponatremia after cord injury LI Cheng△，CHEN Xiao，QIAO Suchi，LIU Chang，ZHU Degang，Wubuli·AZHATI，SU Jiacan，WANG Zhiwei. Department of Orthopedics，Changhai Hospital，Second Military Medical University ，hanghai 200433，China. Corresponding author：WANG Zhiwei. Email: shwangzhiwei@ 【Abstract】ObjectiveTo Methods 251 traumatic cervical cord injury paients were admitted to our hospital from May 2008 to December 2013 and among them 149 cases were diagnosed as hyponatremia.The clinical characteristics, treatment method and outcome were analyzed retrospectively. Results Significant differences showed between hyponatremia group and normal serum sodium group in age, level of injury, with or without brain trauma, with or without infection, and the degree of nerve injury（P 0.05）, while no significant difference was found in gender（P 0.05）.Among 149 cases of hyponatremia, 12 cases were diagnosed as renal sodium loss, and five cases died in the end. The rest cases were diagnosed as central hyponatremia(CSWS 91cases, SIADH 40 cases), of which 116 cases of hyponatremia were cured. The judgement of the other 6 cases was incorrect because of their special clinical features and 2 cases of them died of progressive hyponatremia. ConclusionThe main pathogenesis of hyponatremia after acute cervical cord injury was salt wasting syndrome (CSWS) and the syndrome of inappropriate antidiuretic hormone secretion (SIADH).These two mechanisms are easily confused and the treatment methodsare completely the opposite. So ser