颈髓损伤后低钠血症的临床分析  

Clinical analysis of hyponatremia after cervical cord injury

作　　者：李诚[1] 陈晓[1] 乔苏迟 刘畅[1] 朱德刚[1] 吾不力.阿扎提 苏佳灿[1] 王志伟[1] 

机构地区：[1]上海长海医院骨科,上海200433

出　　处：《上海医学》2015年第1期53-56,共4页Shanghai Medical Journal

摘　　要：目的探讨急性颈髓损伤后低钠血症的临床特点和治疗方法。方法 2008年5月—2013年12月上海长海医院收治外伤性颈髓损伤患者251例,对其中诊断为低钠血症的149例患者的临床特点、治疗方法和结果进行回顾性分析。结果低钠血症组与血钠正常组间年龄、损伤平面、颅脑损伤和感染的构成比的差异均有统计学意义(P值均<0.05),两组间Frankel A级、Frankel B级和Frankel C级构成比的差异有统计学意义(P值均<0.05)。多因素分析结果显示,低钠血症的发生与损伤平面(OR=0.204)、颅脑损伤(OR=0.172)、感染(OR=0.351)、Frankel分级(OR=2.466)相关(P值均<0.05),而与年龄(OR=0.589)、性别(OR=1.225)无关(P值均>0.05)。149例患者低钠血症原因分析,肾外钠丢失12例,脑性盐耗综合征91例、抗利尿激素分泌异常综合征40例,6例患者因中心静脉压<12cmH2O(1cmH2O=0.098kPa)而误诊为脑性盐耗综合征。结论颈髓损伤后低钠血症发病的相关因素较多,其主要发病机制易混淆,治疗时应密切观察患者的血钠水平、尿量、中心静脉压,以及血、尿渗透压,进行综合判断,以决定治疗方案。Objective To investigate the clinical manifestation and treatment of hyponatremia after acute cervical cord injury.Methods A total of 251 patients with traumatic cervical cord injury were admitted to our hospital from May 2008 to December 2013 and 149patients among them were diagnosed as hyponatremia.Clinical manifestation,treatment and outcome of the 149 patients were analyzed retrospectively.Results There were significant differences in age,injured cervical plane,related brain trauma,infection and nerve injury（Frankel A,B and C）between hyponatremia patients and normal serum sodium patients（all P0.05）.Multivariate analysis showed that the incidence of hyponatremia was closely related to injured cervical plane（OR=0.204）,brain trauma（OR=0.172）,infection（OR=0.351）and Frankel classification（OR= 2.466,all P 0.05）,but not related to age（OR=0.589）or gender（OR=1.225,both P0.05）.Among the 149 hyponatremia patients,12 were diagnosed as renal sodium loss,91 were cerebral salt wasting syndrome and 40 were syndrome of inappropriate antidiuretic hormone secretion,while 6 patients were misdiagnosed as cerebral salt wasting syndrome due to low central venous pressure（12cmH2O,1cmH2O=0.098kPa）.Conclusion There are many factors related to the incidence of hyponatremia after acute cervical cord injury and the main pathogenesis are easily confused.So serum sodium,urine output,central venous pressure and urine osmolality should be carefully observed during treatment.The choice of treatment should be based on a comprehensive judgment.

关 键 词：颈髓损伤 低钠血症 脑性盐耗综合征 抗利尿激素分泌异常综合征 

分 类 号：R651.2[医药卫生—外科学]