地震及其它外伤致颈髓损伤后低钠血症的动态观察与治疗
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摘要
【目的】探讨地震及其它外伤致颈髓损伤后低钠血症的发病特点、发病机制和有效治疗方法。【方法】对2008年5月至2008年8月中山大学附属第一医院外科收治地震及其它外伤致颈髓损伤后低钠血症患者的发病特点进行分析,并动态观察比较不同治疗方法对血钠、补钠量、尿钠的影响。【结果】①地震所致和车祸伤所致颈髓损伤低钠血症的临床特点未见不同,低钠血症发生时间为伤后2～20d,血钠可低至112mmol/L或更低,颈髓损伤平面越高,血钠下降的严重程度越严重;②患者出现与低钠程度平行的血氯下降、血浆渗透压下降及尿量增多,血脑钠素明显增高并24h尿钠排除增多;③醋酸去氨加压素、盐皮质激素和限制液体摄入未能改善低钠血症。根据需要增加补钠量至20～75.5g/d,并根据尿量加大补液量至3000～7195mL/d后,患者血钠逐渐恢复正常。【结论】肾性水钠丢失过多是地震及其他外伤致颈髓损伤后低钠血症的主要发病机制,积极补钠、补充血容量是治疗颈髓损伤后低钠血症的关键。
【Objective】 To analyze clinical characteristics, developing mechanism, and treatment of hyponatremia after cervical spinal cord injury caused by earthquake and other trauma. 【Methods】 A prospective observational study was conducted in the patients with hyponatremia after cervical spinal cord injury caused by earthquake and other trauma from May 2008 to August 2008 in The Surgical Department of The First Affiliated Hospital of SUN Yat-sen University. And the change of serum sodium, sodium supplement, urine sodium under different treatments was compared. 【Results】 ①Hyponatremia was found at the 2nd to the 20th day after injury. The serum sodium reached to 112 mmol / L or lower. Clinical characteristics of hyponatremia caused by earthquake showed no difference from those caused by other trauma. The higher the level of cervical cord injury, the more serious the level of hyponatremia. ②Hyponatremia was accompanied with hypo-chloraemia , low serum osmotic pressure, high urine output, high level of serum brain natriuretic peptide, and increase of 24-hour urine volume. ③During the treatment of hyponatremia, desmopressin, mineral corticoid, and limiting fluid intake did not increase the serum sodium level. Patients who were treated with sodium supplement 20 ～ 75.5 g / d and fluid supplement 3 000 ～ 7 195 mL / d showed a gradual increase of serum sodium. 【Conclusion】 Massive urinary sodium and water loss was the major mechanism of hyponatremia after cervical spinal cord injury caused by earthquake and other trauma. Sodium and fluid supplement are the most effective treatments for hyponatremia caused by cervical spinal cord injury.
【Objective】 To analyze clinical characteristics, developing mechanism, and treatment of hyponatremia after cervical spinal cord injury caused by earthquake and other trauma. 【Methods】 A prospective observational study was conducted in the patients with hyponatremia after cervical spinal cord injury caused by earthquake and other trauma from May 2008 to August 2008 in The Surgical Department of The First Affiliated Hospital of SUN Yat-sen University. And the change of serum sodium, sodium supplement, urine sodium under different treatments was compared. 【Results】 ①Hyponatremia was found at the 2nd to the 20th day after injury. The serum sodium reached to 112 mmol / L or lower. Clinical characteristics of hyponatremia caused by earthquake showed no difference from those caused by other trauma. The higher the level of cervical cord injury, the more serious the level of hyponatremia. ②Hyponatremia was accompanied with hypo-chloraemia , low serum osmotic pressure, high urine output, high level of serum brain natriuretic peptide, and increase of 24-hour urine volume. ③During the treatment of hyponatremia, desmopressin, mineral corticoid, and limiting fluid intake did not increase the serum sodium level. Patients who were treated with sodium supplement 20 ～ 75.5 g / d and fluid supplement 3 000 ～ 7 195 mL / d showed a gradual increase of serum sodium. 【Conclusion】 Massive urinary sodium and water loss was the major mechanism of hyponatremia after cervical spinal cord injury caused by earthquake and other trauma. Sodium and fluid supplement are the most effective treatments for hyponatremia caused by cervical spinal cord injury.
引文
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[7]张立,陈贵月,穆保生,等.急性完全性颈髓损伤患者的水电解质紊乱及相关内分泌变化[J].中国脊柱脊髓杂志,2001,11(6):333-336.
[8]明广峰,徐道妙,艾宇航,等.急性颈髓损伤患者低钠血症的治疗[J].中国现代医学杂志,2005,15(10):1575-1576.
[9]Peruzzi WT,Shapiro BA,Meyer PR Jr,et al.Hyponatremia in acute spinal core injury[J].Crit Care Med,1994,22(2):252-258.
[10]关念红,王昆,魏钦令,等.汶川地震异地治疗伤员创伤后应激症状及影响因素分析[J].中山大学学报:医学科学版,2008,29(4):361-366.
[11]王相兰,陶炯,温盛霖,等.汶川地震灾民的心理健康状况及影响因素[J].中山大学学报:医学科学版,2008,29(4):367-371.
[12]Frisbie JH.Salt wasting,hypotension,polydipsia,and hyponatremia and the level of spinal cord injury[J].Spinal Cord,2007,45(8):563-568.
[2]李立新,原晓景,王瑞,等.急性颈髓损伤合并抗利尿激素分泌异常综合征的影响因素[J].中国骨伤,2001,14(8):459-461.
[3]周国昌,赵文良,苑克明,等.急性颈髓损伤并发抗利尿激素分泌异常综合征[J].中国脊柱脊髓杂志,1995,5(3):193-196.
[4]陈亮,权正学.颈髓损伤后的低钠血症[J].中华创伤杂志,2004,20(3):187-189.
[5]Richard HS,Stephen MS.Cerebral Salt Wasting Versus SIADH:What Difference?[J].J Am Soc Nephrol,2008,19(2):194-196.
[6]杨茂伟,吕刚范,广宇.急性颈椎脊髓损伤后低钠血症的临床特点及治疗[J].中华外科杂志,2003,41(8):639-640.
[7]张立,陈贵月,穆保生,等.急性完全性颈髓损伤患者的水电解质紊乱及相关内分泌变化[J].中国脊柱脊髓杂志,2001,11(6):333-336.
[8]明广峰,徐道妙,艾宇航,等.急性颈髓损伤患者低钠血症的治疗[J].中国现代医学杂志,2005,15(10):1575-1576.
[9]Peruzzi WT,Shapiro BA,Meyer PR Jr,et al.Hyponatremia in acute spinal core injury[J].Crit Care Med,1994,22(2):252-258.
[10]关念红,王昆,魏钦令,等.汶川地震异地治疗伤员创伤后应激症状及影响因素分析[J].中山大学学报:医学科学版,2008,29(4):361-366.
[11]王相兰,陶炯,温盛霖,等.汶川地震灾民的心理健康状况及影响因素[J].中山大学学报:医学科学版,2008,29(4):367-371.
[12]Frisbie JH.Salt wasting,hypotension,polydipsia,and hyponatremia and the level of spinal cord injury[J].Spinal Cord,2007,45(8):563-568.
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