颈脊髓损伤患者的低钠血症  

Hyponatremia in Acute Gervical Spinal Cord Injury

作　　者：王新亮[1] 

机构地区：[1]鄂尔多斯市中心医院骨科,内蒙古东胜017000

出　　处：《内蒙古医学杂志》2009年第6期652-654,共3页Inner Mongolia Medical Journal

摘　　要：目的:探讨颈脊髓损伤患者低钠血症的临床患病情况、发生机制、治疗措施及预后。方法:对256例患者中发生低钠血症的168例患者的血钠值进行回顾性统计学分析。结果:256例患者中发生低钠血症者168例,占全部病例的65.6%。168例低钠血症患者中6例出现神经症状,包括神志淡漠、失眠、昏迷、呼吸抑制等,6例患者均接受静点高渗盐水治疗,其中3例患者并加以脱水和限水治疗,所有患者血钠均回升到120 mmol/L以上,但有1例患者因呼吸抑制、深昏迷抢救无效死亡。其余患者预后良好。结论:颈脊髓损伤患者低钠血症的发生率与患者脊髓损伤的程度有正相关性。其发生与钠盐摄入量减少、过量水负荷、脊髓损伤后肾脏排水保钠能力下降等原因有关。治疗原则以积极预防为主,一旦发生低钠血症,应予补充钠盐并适当限水。必须注意急性重度低钠血症致脑水肿的可能。一旦出现神经精神症状,要尽快静点高渗盐水脱水和严格限水治疗。应注意抗利尿激素不适当分泌综合征的可能。颈脊髓损伤患者低钠血症的一般预后良好,但如果忽视急性重度低钠血症致脑水肿的可能,治疗不及时可导致患者呼吸衰竭、昏迷甚至死亡。Objective：To investigate the occurrence rate, time course potential etiologic factors, treatments and prognosis of hyponatremia in patients with acute cervical spinal cord injurg. Methods： Analysis of date obtained from a retrospective databases pertaining to 256 patients with acute cervical spinal cord injury. Results： The mean age of patients was 42.7 ± 14.8 岁;213 of the patients were male and 43 were female, spinal cord injury：complete 76, incomplete 180.6 patients presented with symptoms related central nervous system dysfunction, such as indifference, respiratory depression, ethargy and coma. Treatment measures included administration of hypertonic saline for all 6 patients, fluid restriction and dehydration for 3 patients, and the plasma sodium level of all patients recovered uneventfully to 120 mmol/1, but 1 patients died because of respiratory depression and coma：The others were well prognosis. Conclusions： The occurrence rate of hyponatremia in acute cervical spinal cord injury was correlated to the severity of spinal cord injury. The potential etiologic factors include uncontrolled fluid intake, ingestion of a low salt diet, decreased renal water excretion due to spinal cord injury.

关 键 词：颈脊髓损伤 低钠血症 

分 类 号：R683.2[医药卫生—骨科学]