颈脊髓损伤并发低钠血症的临床分析-外科学(骨外)专业论文.docxVIP

万方数据 万方数据 致伤原因不相关。CSCI并发低钠血症的发病机制主要是SIADH和CSWS，我们认 为CSWS较SIADH更为常见。临床治疗上首先需要明确低钠血症的发病原因，根 据不同的病因采取不同的治疗方案，SAIDH的治疗原则以限水为主，而CSWS的 治疗以积极补液扩充血容量，在此基础上补充丢失的钠盐。CSCI患者并发低钠 血症的治疗关键在于早期积极补钠治疗，减弱或者消除影响低钠血症的相关因 素，提高CSCI并发低钠血症的救治水平和临床治愈率。 【关键词】 颈脊髓损伤；低钠血症；抗利尿激素分泌异常综合征；脑性耗 盐综合征；颅脑损伤 III Clinical analysis of cervical spinal cord injury combined with hyponatremia Major:Surgery(orthopedics) Postgraduate: fuwen Supervisor:Prof.Shang xianwen [Abstract] Objective: To study the correlative influencing factors of cervical spinal cord injury with hyponatremia and analyze the pathogenesis, clinical manifestation,diagnostic method and treatment. Methods: Retrospectively analysis the clinical data of 73 CSCI cases received and cured on march 2013 to february 2015 in department of orthopedics of Affiliated Hospital of Guiyang Medical College, and they were divided into hyponatremia group and control group according to the blood sodium level. Chi-square test and Logistic regression were used to analyze the relative factors such as age, cause, craniocerebral injury, infection, degree of spinal injury and ventilator. Periodic monitoring method was performed to investigate the level of the blood sodium, urinary sodium, 24 hours urine volume, blood osmotic pressure and urine osmotic pressure after hyponatremia determined, and the cause of low sodium with SIADH or CSWS was determined according to the monitoring results and therapeutic reaction. The treatment of SIADH need closing confinement of water intake until low sodium correction and that of CSWS need energetic rehydration to expand blood volume that would supply the losed sodium salt. The level of serum sodium before and after therapy was statistical analyzed. Results: The fasting serum sodium level of 73 CSCI cases was 131±4.38 (mmol/L). There were 26 hyponatremia cases and the incidence rate was 35.62%. There were 7 mild hyponatremia cases with incidence rate of 9.59%, and 10 moderate hyponatremia cases with incidence rate of 13.7%, an