不同程度颈脊髓损伤后低钠血症的临床分析

 目的回顾性总结急性颈脊髓损伤后低钠血症的发生特点,并分析其可能的发生原因,以及脊髓损伤严重程度、性别、年龄等因素对血钠变化的影响。方法研究对象为2005年6月至2011年3月急诊收治的一组颈椎外伤患者,排除合并颅脑外伤及慢性疾病的患者,入选病例分为完全性脊髓损伤组、不完全性脊髓损伤组及无神经功能障碍组,回顾性分析各组病例的血钠变化情况。结果入选病例共102例,男83例,女19例;年龄17~68岁,平均45.6岁。完全性脊髓损伤组23例,不完全性脊髓损伤组60例,无神经功能障碍组19例。共发生低钠血症共39例,完全性脊髓损伤组15例(65%),不完全性脊髓损伤组23例(38%),无神经功能障碍组1例(5%)。低钠血症发生率在三组间两两比较,差异有统计学意义,完全性脊髓损伤组低钠血症的发生率明显高于不完全性脊髓损伤组和无神经功能障碍组。Logistic逐步回归分析结果显示低钠血症与患者脊髓损伤程度有明确相关关系,而与患者的年龄、性别、脊髓损伤节段无相关关系。结论急性颈脊髓损伤后具有较高的低钠血症发生率,虽然影响钠盐平衡的因素及相互作用非常复杂,但颈脊髓损伤致自主神经功能障碍、神经内分泌功能异常以及血液动力学改变可能是导致颈脊髓损伤后电解质系统异常的重要原因。

Clinical analysis of hyponatremia after different extent of traumatic cervical spinal cord injury

Objective To analyze the incidence and possible etiological factors of hyponatremia after acute cervical spinal cord injury (CSCI), and evaluate the effect of severity of CSCI, age, sex and injured segment on hyponatremia. Methods From June 2005 to March 2011, a series of patients with CSCI caused by cervical vertebras trauma were treated in our department. Except patients combined with craniocerebral injury or chronic diseases, other patients were divided into three groups: complete CSCI group, incomplete CSCI group and no neurological disorder group. Concentration of natrium in blood in all patients was analyzed respectively. Results All 102 patients (83 males, 19 females) were selected with an average of 45.6 years old. There were 23 patients with complete CSCI, 60 with incomplete CSCI and 19 with no neurological disorder. Hyponatremia was found in 15 patients in complete CSCI group, 23 patients in incomplete CSCI group and 1 patient in no neurological disorder group. The incidence of hyponatremia was significantly different between three groups, among which the complete CSCI group had the highest incidence. Multiple linear regression analysis showed hyponatremia was obviously correlated with the injury degree of spinal cord, but not correlated with the age, sex and injury segment of the patients. Conclusion Hyponatremia is a common complication in patients suffered from CSCI. Although the balance of natrium in blood is very complicated and influenced by many factors, autonomic nerve system and neuroendocrine system dysfunction, and hemodynamic changes after CSCI may play a key role in happening of electrolytical abnormality.