急性颈髓损伤后低钠血症发生机制及相关因素  

Mechanism and correlation factor of hyponatremia in patients with acute cervical spinal cord trauma

作　　者：赵磊[1] 王帅[1] 宋朝晖[1] 吴春生[1] 彭阿钦[1] 

机构地区：[1]河北医科大学第三医院创伤急救中心四区,石家庄050051

出　　处：《中国矫形外科杂志》2013年第2期127-131,共5页Orthopedic Journal of China

基　　金：国家科技支撑计划资助项目(编号:2011BAF01B05)

摘　　要：[目的]探讨急性颈髓损伤后低钠血症的发生机制、相关因素及临床诊治原则。[方法]检测52例急性颈椎损伤后连续10 d的空腹电解质、血压、出入量的情况,根据Frankel评分标准,利用统计学方法,比较分析损伤平面、损伤程度等因素对低钠血症的影响,分析平均动脉压及24 h出入量的变化情况及与低钠血症的关系。[结果]52例患者中,颈髓损伤38例,其空腹血钠值为(134.7±5.13)mmol/L,血压为(101.4±5.21/78.6±4.81)mmHg(1mmHg=0.133 kPa),24 h入量为(5 810±493.18)ml,出量为(5 450±497.21)ml。无颈髓损伤的14例,其空腹血钠值为(139.8±2.18)mmol/L,血压为(127.2±2.81/84.6±3.42)mmHg,24 h入量为(2 890±255.82)ml,出量为(2 580±214.99)ml。伤后低钠血症的出现时间是5.2～8.3 d。[结论]低钠血症的严重程度与颈髓损伤的严重程度呈正相关,而与颈椎损伤节段无明显相关性。颈髓损伤越严重的患者,往往伴随严重的低血压,同时低钠血症也非常严重。在颈髓损伤患者的24 h出量和入量明显增加。[ Objective] To investigate the mechanism and correlation factors of hyponatremia in patients with acute cervical spinal cord trauma and principle of clinical diagnosis and treatment. [ Method ] Fasting blood electrolyte values in 52 patients were tested in 10 days after the cervical spirial trauma. The data of blood pressure and intake and output volumes were recor- ded. According to the Frankel criteria, using statistic methods, some factors affecting hyponatremia including injury level and se- verity were compared, the change rules of mean arterial pressure and the intake and output volumes of 24 hours and the relativity with hyponatremia were analyzed. [ Result] Fasting blood sodium value was （134. 7 ± 5. 13 ） mmol/L, blood pressure value was （ 101.4 ±5.21/78. 6 ± 4. 81 ） mmHg, the intake volumes of 24 hours was （ 5810 ±493.18 ） ml and the output volumes of 24 hours was （5450 ±497. 21 ） ml in 38 patients with aetue spinal cord injury. Fasting blood sodium value was （ 139. 8 ± 2. 18 ） mmol/L,blood pressure value was （127.2 ± 2. 81/84. 6 ± 3.42 ） mmHg and the intake volumes of 24 hours was （2890 ± 255.82） ml and the output volumes of 24 hours was （2580 ± 214. 99） ml in 14 patients without actue spinal cord injury. The occurrence time of post - traumatic hyponatremia was 5.2 - 8.3 days. [ Conclusion] The severity of hyponatremia is related to the severity of spinal cord injury,is not related to level of cervical spinal injury. The more severe spinal cord injury is, the more severe hypotension and hyponatremiais is. The intake and output volumes of 24 hours increases obviously in patients with aetue spinal cord injury.

关 键 词：颈髓损伤 颈椎外伤 低钠血症 相关因素 低血压 

分 类 号：R681.5[医药卫生—骨科学]