颈髓损伤后低钠血症临床分析.doc

颈髓损伤后低钠血症临床分析
李诚△,陈晓△,乔苏迟,刘畅,朱德刚,吾不力·阿扎提,苏佳灿,王志伟
【摘要】目的探讨急性颈髓损伤后低钠血症的临床特点以及治疗方法。方法 2008年5月至2013年12月间我院收治外伤性颈髓损伤病人251人,其中诊断为低钠血症的患者有149例。对其进行临床特点、治疗方法及结果进行回顾性分析。结果低钠血症组与血钠正常组在年龄、损伤平面、有无脑外伤、有无合并感染、神经损伤程度具有显著差异(P <),在性别上无显著差异(P >)。149例低钠血症病人中12例诊断为肾外钠丢失,死亡5人;其余为中枢性低钠(CSWS 91例,SIADH 40例),其中116例低钠血症得以纠正;另外6例患者由于临床特点特殊导致判断错误,其中2例因进行性低钠血症死亡。结论颈髓损伤后低钠血症主要发病机制为脑性盐耗综合征(CSWS) 和抗利尿激素分泌异常综合征(SIADH)两种,两种机制容易混淆,治疗方法完全相反,治疗时需密切观察患者血钠、症状、尿量、CVP、血尿渗透压变化综合判断以决定治疗方案。
【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
Clinical analysis of hyponatremia after cervical cord injury
LI Cheng△,CHEN Xiao△,QIAO Suchi,LIU Chang,ZHU Degang,Wubuli·AZHATI,SU Jiacan,WANG Zhiwei. Department of Orthopedics,Changhai Hospital,Second Military Medical University ,Shanghai 200433,China.
Corresponding author:WANG Zhiwei. Email: ******@vip.
作者单位:200433 上海,第二军医大学附属长海医院骨科。
通讯作者:王志伟,邮箱:******@vip.
△李诚与陈晓为并列第一作者
【Abstract】ObjectiveTo investigate the clinical characteristics and treatment methods of hyponatremia after acute cervical cord injury. Methods 251 traumatic cervical cord injury paients were admitted to our hospital from May 2008 to December 2013 and among them 149 cases were diagnosed as clinical characteristics, treatment method and e were analyzed retrospectively. Results Significant differences showed between hyponatremia group and normal serum sodium group in age, level of inj