氢化可的松及地塞米松对颈髓损伤继发低钠血症的不同影响

目的:持续、严重的低钠血症是颈髓损伤常见的并发症,目前尚无有效的治疗方法。评价氢化可的松及地塞米松两种糖皮质激素对急性颈髓损伤继发低钠血症的不同影响而进行本研究。方法:急性完全性颈髓损伤共32例,分为氢化可的松组12例及地塞米松组20例,分别在入院后静脉使用氢化可的松150mg/d或地塞米松20mg/d,共5～6d。测定两组的血清K+、Na+、Cl-浓度变化、液体出入量、24h尿K+、Na+、Cl-排出总量。结果:与地塞米松组相比,氢化可的松组低钠血症发生率及程度较低,其低钠血症的开始出现时间、达到最低点时间较晚,每日尿量及24h尿Na+排出量较低(P<0.05)。结论:在颈髓损伤早期使用糖皮质激素时,选用有较强盐皮质激素样作用的氢化可的松,对继发性低钠血症的发生及其严重程度均有一定的抑制作用。

The different role of hydrocortisone and dexamethasone to the secondary hyponatramia after acute cervical spinal cord injury

AIM: Enduring and severe haponatremia is a very common complication after acute cervical spinal cord injury (ACSCI).The goal of the present study is to evaluate the different roles of hydrocortisone and dexamethasone to the secondary hyponatramia after ACSCI. METHODS:ACSCI 32 cases were divided into two groups, hydrocortisone group 12 cases and dexamethasone group 20 cases, which were with hydrocortisone 150 mg/d or dexamethasone 20 mg/d with 5 to 6 days after hospitalization.To Assay the changes of serum K+,Na+,Cl-concentrations, volume of urine and fluid replacement, 24 h excretion of K+,Na+,Cl-in urine in the two groups retrospectively.RESULTS:In hydrocortisone group, the morbidity and severity of hyponatramia were lower, the initiation and nadir were later, volume of urine and fluid replacement and 24 h excretion of Na+in urine were less than those in the dexamethasone group retrospectively(P< 0.05).CONCLUSION:The administration of hydrocortisone in the early of ACSCI can inhibit the secondary hyponatramia after ACSCI.