急性完全性颈髓损伤继发顽固性低钠血症的发病机制及治疗方法探讨  

Study about mechanism and treatment methods of refractory hyponatremia after complete acute cervical sinpal cord injury

作　　者：孙厚杰[1] 杨永辉[2] 蔡小军[1] 韩建华[1] 周鑫[1] 范华华[1] 

机构地区：[1]贵州遵义医学院第三附属医院脊柱外科,563000 [2]陕西省宝鸡市中医医院骨科,721000

出　　处：《内蒙古中医药》2013年第31期54-55,共2页Inner Mongolia Journal of Traditional Chinese Medicine

摘　　要：目的:探讨急性颈脊髓损伤(acute cervical sinpal cord injury,ACSCI)后低钠血症的发病机制及治疗方法。方法:自2009年1月至2011年6月我科收治的急性完全性颈脊髓损伤(ACSCI)继发低钠血症患者11例,男8例,女3例,年龄22—78岁,平均36.35岁,受伤时间2h-72h,平均7.25h。对该11例ACSCI后低钠血症患者进行回顾性分析,根据患者的体温、血压、心率、24h尿量、血钠、血钙、血氯、血钾和尿钠等指标推测可能的发生机制,并酌情补液、限液及高渗钠等治疗观察分析。结果:11例患者经初期扩容治疗后3例度过低钠血症期,出现低钠血症8例患者中2例继续补液+高渗钠静脉缓慢滴注,2-3周血钠恢复正常,6例在保证生理需要量前提下,酌情限液+高渗钠液补钠微泵泵人,2-3周血钠恢复正常,两组均未发生其它离子紊乱及神经脱髓鞘现象。结论:交感神经系统受抑制是ACSCI后低钠血症的发病机制之一。初期扩容治疗可起到缓解低钠血症病情的作用。Objective To investigate Mechanism and treatment methods of refractory hyponatremia after complete acute cervical sinpal cord injury （ACSCI） Methods： From Jan 2009to Jun 2011,11 patients underwent hyponatremia after ACSCI included 8 males, 3 females, ranging in age from 22 to 78 years, with an average of 36.35 years. The time of injury is from 2 to 72 hours.The average time is 7.25 hours. 11 patients with sever hyponatremia were reviewed. According to patient＇ s temperature, blood pressure, heart rate, 24h urine volume, sodium, calcium, senJm chloride, potassium anti urinary sodium, etc,its possible mechanism st^culated .To analysis treatment outcomes by way of hyperlonic salt supplement and appropriate Increasing blood vohnne or restriction of water intake. Results： 11 patients underwent appropriate increasing blood volume beginning. No hyponatremia in 3 patients, h）7~onatremia in 8 patients： Serum sodium recovery after 2-3 week in 2 patients with continued increasing blood volume and hyperlonic salt supplement, The same result in 6 patients with appropriate restriction of water intake anti hypertonic salt supplement. Ion disorder or phenomenon of neuropathy had no occurrence in 2 group patients.Conclusion：One of the mechanism of refractory hyponatre, mia ＇after ACSCI could be attributed to sympathetic restrained. Increasing blood volume can play the role to alleviate hyponatremia condition.

关 键 词：颈脊髓 创伤和损伤 低钠血症 发病机制 治疗 

分 类 号：R651.2[医药卫生—外科学]