急性颈脊髓损伤后轻中度低钠血症的液体管理  

The fluid management for mild and moderate hyponatremia after acute cervical spinal cord injury

作　　者：张仲汇[1] 韩岳[1] 颜柳子[1] 

机构地区：[1]天津市天津医院重症监护病房,天津300211

出　　处：《天津医科大学学报》2011年第4期509-511,共3页Journal of Tianjin Medical University

摘　　要：目的:探讨急性颈脊髓损伤(ACSCI)后出现轻中度低钠血症时采用不同液体管理策略对疗效的影响。方法:采用前瞻性随机对照研究。选取外伤致ACSCI并发轻中度低钠血症者48例,随机分为A、B两组,每组24人,在同样基础治疗的前提下,A组进行限制性液体管理,B组实行开放性液体管理策略,分别记录两组自开始补钠治疗后24 h和72 h血钠、平均动脉压(MAP)、中心静脉压(CVP)、24 h尿量、24 h尿钠、尿渗透压/血渗透压。结果:治疗24 h后A组血钠、MAP、CVP、24 h尿量、24 h尿钠、尿渗透压/血渗透压与B组比较无统计学意义。治疗72 h后A组血钠([128.98±4.32)mmol/L]、MAP([64.32±3.25)mmHg]、CVP([5.14±0.68)cmH2O]低于B组血钠([138.64±5.78)mmol/L]、MAP([74.89±5.21)mmHg]、CVP([7.93±0.81)cmH2O(]P<0.05);A组24 h尿量([2 100.32±32.21)mL]、24 h尿钠([189.25±11.21)mmol/L],尿渗透压/血渗透压(2.78±0.79)高于B组尿量([1 915.54±27.65)mL]、24 h尿钠([34.67±8.12)mmol/L],尿渗透压/血渗透压(1.64±0.31)(P<0.01)。结论:对于大部分ACSCI后并发轻中度低钠血症的患者,开放性液体管理策略较之限制性液体管理策略能更快地纠正低钠血症及其相关并发症。Objective： To explore the influence of different fluid management on mild and moderate hyponatremia after acute cervical spinal cord injury （ACSCI）. Methods： Prospective randomized control trial was carried out in Intensive Care Unit. 48 adult patients suf fered mild and moderate hyponatremia after ACSCI were chosen and randomly divided into two groups （n=24 each）： conservative fluid management （group A） and liberal fluid management group （group B ）. The parameters of serum sodium, mean arterial pressure（MAP）, central venous pressure （CVP）, urine volume of 24 h, urine sodium of 24 h, urine osmoticpressure/sodium osmoticpressure at 24 h,72 h after treatment were recorded and analysed. Results： Comparing with the parameters of group A and B, there were no statistics meaning about serum sodium, MAP, CVP, urine volume of 24 h, urine sodium of 24 h, urine osmoticpressure/sodium osmoticpressure after 24 h different treatments. At 72 h after treatments, serum sodium[（128.98±4.32）mmol/L] ,MAP[（64.32±3.25）mmHg],CVP[（5.14±0.68）cmH2O] in group A were lower than those in group B（P〈0.05 ）. Urine volume of 24 h[（2 100.32±32.21）mL],urine sodium of 24 h [（189.25±11.21） mmol/L], urine osmoticpressure/sodium osmoticpressure（2.78±0.79）in group A were higher than those in group B （P〈0.01）. Conclusion： The mild and moderate hyponatremia and interrelated complications after ACSCI can be retrieved earlier by liberal fluid management than conservative fluid management.

关 键 词：脊髓损伤 急性病 低钠血症 液体管理 

分 类 号：R651.2[医药卫生—外科学]