急性颈髓损伤患者的水钠代谢变化及其机制(英文)  

Changes of water-sodium metabolism and its possible mechanism in patients with acute cervical spinal cord injury

作　　者：张立[1] 阿拉塔[1] 蔡钦林[1] 刘忠军[1] 党耕町[1] 

机构地区：[1]北京大学第三医院骨科,北京市100083

出　　处：《中国临床康复》2004年第14期2766-2767,共2页Chinese Journal of Clinical Rehabilitation

摘　　要：背景:大多数急性颈髓损伤患者可继发严重的水钠代谢紊乱,但其发生机制还不清楚。目的:研究急性完全性颈髓损伤患者继发的水钠代谢紊乱及尿中前列腺素PGE2排出量的相应变化,探讨颈髓损伤患者继发水钠代谢紊乱的发生机制。设计:以诊断为依据的病例对照研究。地点、对象和方法:实验在北京大学第三医院骨科完成,研究对象为完全性颈髓损伤(CSCI)组患者28例,其中男19例,女9例;年龄(37.14±9.39)岁;对照组为同期骨科住院的非脊髓损伤和急性创伤患者18例,男13例,女5例,年龄(38.11±11.89)岁。检测两组水钠代谢和尿前列腺素PGE2的变化。主要观察指标:两组血压心率、血电解质、尿量、液体入量以及尿电解质排出量的变化,尿前列腺素PGE2的变化。结果:CSCI组血Na+浓度犤(132.70±3.20)mmol/L犦低于对照组(t=2.01,P<0.01),低钠血症发生率为92.9%;CSCI组尿量(3610±761)mL/d,Na+排出量(473.7±169.4)mmol/d均高于对照组(分别为t=2.01,P<0.01;t=2.08,P<0.05);血压、心率均低于对照组(t=2.01,2.01,P<0.01);24h尿PGE2排出量高于对照组(t=2.04,P<0.01)。结论:颈髓损伤后交感神经系统抑制,血压降低,肾血流量减少,肾皮质缺血缺氧,继而刺激肾脏前列腺素合成增多,产生利钠利尿作用,可能是颈髓损伤继发低钠血症的发生机制之一。BACKGROUND:Although secondary severe water electrolyte imbalance was a common complication after acute cervical spinal cord injury(CSCI),its mechanism remains unknown. OBJECTIVE:To investigate the water sodium imbalance and the corresponding changes of urinary prostaglandin E2(PGE2) in patients with acute complete CSCI and analyze its possible mechanism. DESIGN:A diagnosis based case control trial was conducted. SETTING,PARTICIPANTS and METHODS:The trial was completed in the Department of Orthopaedics,Peking University Third Hospital.Twenty eight acute complete CSCI patients,including 19 males and 9 females,were included as the trial group(CSCI group).Eighteen cases,including 13 males and 5 females,were included in the control group.Their average ages were (37.14±9.39) years and (38.11±11.89) years,respectively.The changes of water sodium metabolism and the PGE2 were detected. MAIN OUTCOME MEASURES:The changes of blood pressure,heart rate,blood electrolytes concentrations,volume of urine and fluid intake,and electrolytes excretion in urine were measured.The changes of PGE2 in urine were also detected. RESULTS:Hyponatremia occurred in 26 cases(92.9%) in CSCI group.The average concentration of serum sodium in CSCI group[(132.70±3.20) mmol/L] was significantly lower than that in control group(t=2.01,P< 0.01).The urine volume[(3 610±761) mL/day] and sodium excretion in 24 hours urine[(473.7±169.4) mmol/day] were significantly larger than those in control group(t=2.01,P< 0.01 and t=2.08,P< 0.05,respectively).Meanwhile,the blood pressure and heart rate in CSCI group were both significantly lower than those in control group(comparison of systolic pressure:t=2.01,P< 0.01;comparison of diastolic pressure:t=2.01,P< 0.01;comparison of heart rate:t=2.01,P< 0.01),and the total amount of PGE2 in 24 hours urine in CSCI group was significantly higher than that in control group(t=2.04,P< 0.01). CONCLUSION:Acute CSCI may result in inhibition of sympathetic system,low blood pressure,decreased renal blood flow

关 键 词：脊髓损伤 水电解质失调 低钠血症 前列腺素 

分 类 号：R681.5[医药卫生—骨科学]