颈髓损伤低钠血症治疗28例分析

目的:探讨颈髓损伤合并低钠血症患者的治疗。方法:28例颈髓损伤合并低钠血症患者经限水补钠或补液补钠治疗,12例持续中心静脉压监测。结果:低钠纠正时间为4~22 d,平均10.5 d,2例死亡。结论:低钠血症纠正与颈髓损伤严重程度正相关,选择限水补钠或补液补钠以中心静脉压监测更合理。     

急性颈髓损伤患者继发低钠血症的观察与护理

报告了21例急性颈髓损伤患者继发低钠血症的观察与护理.重点为观察低钠血症时出现的精神异常和意识状态改变,监测血浆电解质和血浆渗量的变化、尿量和尿钠的改变,探讨补液、补钠正确方法及早期饮食、饮水干预对低钠血症的预防作用.本组有16例未经早期干预全部发生了低钠血症,除6例自动出院外,10例经过限水补钠治疗后全部治愈;另有5例经早期饮食、饮水干预,有4例未发生低钠血症.认为应当提高临床护士对此并发症的认识,早期增加钠的摄入可以有效预防低钠血症的发生,出现低钠血症后正确补钠,可以及时纠正低钠,有利于患者的康复.     

急性颈髓损伤合并低钠血症的治疗

低钠血症是急性颈髓损伤最常见并发症 ,由于该并发症的发病机制尚不清楚 ,因而 ,对其治疗存在较大的争论。1997- 0 7～2 0 0 2 - 10共收治急性颈髓损伤 4 3例 ,其中 2 3例合并低钠血症 ,现就其治疗报告如下。1　对象和方法1.1　对象　因外伤所致急性颈髓损伤合并低钠血症 2 3例 ,男17例 ,女 6例 ;年龄 2 6～ 72岁 ,平均 35 .8岁。患者从受伤到出现低钠血症最短的 3d,最长的 15 d,平均 7.4 d± 3.5 d。截瘫的程度分别为 :完全性 (Frankel A) 7例 ,不完全性损伤 (Frankel B以下 ) 16例。合并颅脑损伤的 7例。1.2　诊断标准　排除糖尿病、高…     

颈髓损伤高位截瘫并发低钠血症23例的护理

目的 探讨对颈髓损伤高位截瘫患者并发低钠血症的护理.方法 通过2006-04-2010-04以来23例患者的临床治疗观察,总结护理经验.结果 23例患者除1例放弃治疗外,其余22例均治愈.结论 对颈髓损伤高位截瘫患者护理中应重视观察神志、生化指标、尿量等,低钠时应合理补钠,预防截瘫患者的并发症,避免低钠血症的发生和发展,只有提高低钠血症的认识,才能使患者早日康复.     

老年人颈脊髓损伤伴发低钠血症的观察与护理

对我院老年人颈脊髓损伤伴发低钠血症的观察与护理总结如下. 1 临床资料 本组男18例,女9例,年龄65～90（平均76.4）岁.高处坠落伤9例,骑车摔倒5例,车祸6例,其他7例为不同外伤所致.住院时间14～70（平均26） d.低钠血症发生于住院后2～19 d.     

急性颈髓损伤后低钠血症37例临床分析

目的:探讨急性颈髓损伤后低钠血症的治疗.方法:回顾性分析2008年1月-2010年12月收治的急性颈髓损伤后低钠血症患者37例的临床资料.结果:血钠在120-130 mmol/L的32例经补盐和限制水摄入量治疗2-3周后低钠症状改善;血钠<120 mmol/L的5例,治疗6-8周后恢复正常2例,死亡3例.结论:颈髓损伤后低钠血症发生率与损伤程度密切相关,及早发现并补充钠盐和控制液体量是有效的治疗方法;能量支持及维持胶体渗透压能提高疗效.     

颈髓损伤所致低钠血症患者的临床表现与治疗

颈髓损伤是一种严重的创伤,除了颈髓损伤本身给患者造成伤残外,多种并发症的存在不但影响损伤脊髓功能的恢复,有时甚至可以危及生命。低钠血症是颈髓损伤患者早期常见的但往往容易被忽视的并发症[1] ,我们对1997年1月～2 0 0 3年6月住院治疗的颈髓损伤患者低钠血症的临床表现及治疗情况进行回顾性分析,以探讨颈髓损伤患者低钠血症的病因、治疗及预防措施。1　临床资料1.1　一般资料　颈髓损伤患者10 7例,除外颅脑及其它部位的损伤,排除糖尿病、心脑血管疾病、肝肾疾病,纳入本文研究的单纯性颈髓损伤合并低钠血症的患者6 9例。其中男5 6例,女…     

急性颈髓损伤继发低钠血症的研究进展

低钠血症是急性颈髓损伤后常见并发症,文献报道其发生率为45％～100％。在临床由于认识不足,常延误诊断和治疗,影响患者预后及康复,甚至危及生命。因此,对急性颈髓损伤后出现的低钠血症,必须给予足够重视,做到早发现,积极治疗,正确补钠。为了提高护士对低钠血症的认识水平,笔者从发病机制、临床表现及实验室检查、治疗方法、观察护理等方面进行综述。     

急性颈髓损伤与低钠血症

有关急性脊髓损伤伴发低钠血症的研究报道并不多见,专业医生更多注重如何尽快解决脊髓损伤带来的神经功能的恢复问题。然而,急性期低钠血症的发生会明显影响临床的预期效果,因为低钠血症会带来全身性的代谢紊乱。一组研究资料显示,在颈髓损伤完全四肢瘫痪的患者中,45%的患者会发生低钠血症,不全四肢瘫痪的患者中其发生率也可达20%[1]。Peruzzi等[2]对一组282例急性脊髓损伤患者的研究中发现,脊髓损伤Frankel分级为A级的患者其低钠血症的发生率可达到62%,并且明显高于Frankel分级B(48%)、C(41%)、D(23%)或E级(16%)的患者。2001年9月至200…     

完全性颈脊髓损伤患者并发低钠血症的临床观察与分析

目的:为完全性颈脊髓损伤并发低钠血症的发病机制做出新解释,为治疗提出新方案,为进一步研究提出新问题.方法:回顾性研究5例颈脊髓损伤伴发低钠血症患者的治疗方法及临床疗效,结合相关文献进行系统分析,否认用稀释性低钠或盐耗性低钠理论来解释与指导完全性颈脊髓损伤并发低钠血症的治疗.结果:利用原发病机制的新解释指导的治疗方案,5例患者治疗效果良好,无一例出现顽固性低钠及心力衰竭等并发症.结论:颈髓损伤伴发低钠血症是机体生理功能调节的再平衡,是复杂的、贯序的、相互影响的过程,绝不能从单一方面(稀释性低钠或盐耗性低钠)来理解这一问题.积极补液、扩容、升血压、补钠对治疗完全性颈脊髓损伤患者并发低钠血症效果明显.     

无骨折脱位型颈髓损伤的治疗

[目的]探讨无骨折脱位型颈髓损伤的病理基础、治疗方法的选择和治疗效果.[方法]根据26例无骨折脱位型颈髓损伤患者的MRI检查,按不同的特点分为四种类型,采用不同方法进行治疗.[结果]26例术后随访5个月至9年,平均3.9年.前路手术固定节段均获骨性融合,内固定物无松动、断裂,后路手术无再关门现象,术后MRI检查显示椎管容积扩大,颈髓受压缓解.2例术后脊髓功能无改善,其余患者均有不同程度恢复.[结论]无骨折脱位型颈脊髓损伤应尽早行MRI检查,以明确临床类型.对颈脊髓受压明显者,应尽早采用不类型的手术治疗,对无颈脊髓受压者采用大剂量甲基强的松龙等非手术治疗,亦具有较好的疗效.     

急性颈髓损伤并发低钠血症的护理干预

目的探讨急性颈髓损伤并发低钠血症的护理干预措施。方法回顾性分析11例急性颈髓损伤并发低钠血症患者的护理干预,包括重点监测血钠、尿量和尿钠的改变,观察患者意识状态和生命体征变化,注意早期饮食、饮水的干预,重视高热护理、心理干预,实施正确的补液、补钠和抗利尿治疗等。结果10例患者血钠均逐渐恢复正常,症状好转出院;1例患者自行出院。结论早期发现和正确及时诊断急性颈髓损伤后并发低钠血症十分重要,给予恰当的治疗及护理于预对于纠正低钠血症、改善患者的预后尤为关键。     

无骨折脱位型颈脊髓损伤合并颈椎病治疗及影响因素

目的　分析无骨折脱位型颈脊髓损伤合并颈椎病的疗效和影响因素。方法　对 30例患者进行回顾性研究。结果　 1合并脊髓型者脊髓功能恢复停滞早于神经根者 ,而且差。但是后期二者脊髓功能均出现恶化。 2手术效果明显优于保守疗法。 3无论合并何型颈椎病 ,远期疗效与手术时机均呈负相关 (P<0 .0 5 )。 4远期疗效与合并脊髓型的病程呈负相关 (P<0 .0 5 )。结论　早期手术是此类损伤首选疗法。合并脊髓型者更应尽早手术。     

护理干预对颈髓损伤后低钠血症的影响

目的探讨护理干预对颈髓损伤后低钠血症的影响。方法 60例颈髓损伤伴低血钠患者分成对照组(n=30)和护理干预组(n=30)。对照组未给予相关低钠血症的护理干预,护理干预组由责任护士给予相关低钠血症的护理干预。对1个月后两组的血清钠值及病程进行分析。结果 1个月后护理干预组血钠值明显高于对照组(P<0.01),并且护理干预组病程较对照组明显缩短(P<0.01),病情反复病例较对照组少(P<0.05)。结论护理干预有利于改善颈髓损伤患者的低钠血症。     

Depression Treatment Preferences After Acute Traumatic Spinal Cord Injury

Objective

To examine preferences for depression treatment modalities and settings and predictors of treatment preference in persons with spinal cord injury (SCI).

Design

Cross-sectional surveys.

Setting

Rehabilitation inpatient services.

Participants

Persons with traumatic SCI (N=183) undergoing inpatient rehabilitation.

Interventions

Not applicable.

Main Outcome Measures

Patient Health Questionnaire-9 depression scale, history of psychiatric diagnoses and treatments, and a depression treatment preference survey.

Results

Among inpatients with SCI (28% had Patient Health Questionnaire-9 score ≥10 indicating probable major depression), a physical exercise program was the most preferred treatment option (78% somewhat or very likely to try) followed by antidepressants prescribed by a primary care provider (63%) and individual counseling in a medical or rehabilitation clinic (62%). All modalities were preferred over group counseling. Although not statistically significant, more depressed individuals stated a willingness to try antidepressants and counseling than nondepressed individuals. Subjects preferred treatment in a medical/rehabilitation setting over a mental health setting. Those with a prior diagnosis of depression and a history of antidepressant use were significantly more willing to take an antidepressant. Age ≥40 years was a significant predictor of willingness to receive individual counseling.

Conclusions

Treatment preferences and patient education are important factors when choosing a depression treatment modality for patients with SCI. The results suggest that antidepressants, counseling, and exercise may be promising components of depression treatment in this population, particularly if they are integrated into medical or rehabilitation care.     

Venous Thromboembolism After Spinal Cord Injury

Teasell RW, Hsieh JT, Aubut JL, Eng JJ, Krassioukov A, Tu L, for the Spinal Cord Injury Rehabilitation Evidence Review Research Team. Venous thromboembolism after spinal cord injury.

Objective

To review systematically the published literature on the treatment of deep venous thromboembolism after spinal cord injury (SCI).

Data Sources

MEDLINE/PubMed, CINAHL, EMBASE, and PsycINFO databases were searched for articles addressing the treatment of deep venous thromboembolism post-SCI. Randomized controlled trials (RCTs) were assessed for methodologic quality using the Physiotherapy Evidence Database Scale, while non-RCTs were assessed using the Downs and Black evaluation tool.

Study Selection

Studies included RCTs, non-RCTS, cohort, case-control, case series, pre-post, and postinterventional studies. Case studies were included only when no other studies were available.

Data Extraction

Data extracted included demographics, the nature of the study intervention, and study results.

Data Synthesis

Levels of evidence were assigned to the interventions using a modified Sackett scale.

Conclusions

Twenty-three studies met inclusion criteria. Thirteen studies examined various pharmacologic interventions for the treatment or prevention of deep venous thrombosis in patients with SCI. There was strong evidence to support the use of low-molecular-weight heparin in reducing venous thrombosis events, and a higher adjusted dose of unfractionated heparin was found to be more effective than 5000 units administered every 12 hours, although bleeding complications were more common. Nonpharmacologic treatments were also reviewed, but again limited evidence was found to support these treatments.     

Community Reintegration in Rehabilitated South Indian Persons With Spinal Cord Injury

Samuelkamaleshkumar S, Radhika S, Cherian B, Elango A, Winrose W, Suhany BT, Prakash MH. Community reintegration in rehabilitated South Indian persons with spinal cord injury.

Objectives

To explore community reintegration in rehabilitated South Indian persons with spinal cord injury (SCI) and to compare the level of community reintegration based on demographic variables.

Design

Survey.

Setting

Rehabilitation center of a tertiary care university teaching hospital.

Participants

Community-dwelling persons with SCI (N=104).

Interventions

Not applicable.

Main Outcome Measures

Craig Handicap Assessment and Reporting Technique (CHART).

Results

The mean scores for each CHART domain were physical independence 98±5, social Integration 96±11, cognitive independence 92±17, occupation 70±34, mobility 65±18, and economic self sufficiency 53±40. Demographic variables showed no statistically significant difference with any of the CHART domains except for age and mobility, level of education, and social integration.

Conclusions

Persons with SCI in rural South India who have completed comprehensive, mostly self-financed, rehabilitation with an emphasis on achieving functional ambulation, family support, and self-employment and who attend a regular annual follow-up show a high level of community reintegration in physical independence, social integration, and cognitive independence. CHART scores in the domains of occupation, mobility, and economic self-sufficiency showed lower levels of community reintegration.