颈髓损伤后水电解质紊乱的临床诊断治疗

目的 探讨颈髓损伤后电解质紊乱的临床特点及诊断治疗.方法 回顾30例颈髓损伤患者（完全性损伤15例，不完全性损伤15例）血压、心率，血清钠、钾、血浆渗透压、尿量及24ｈ尿钠排出量等资料：23例患者于伤后2－8天出现低钠血症，其中完全性损伤15例全部出现，发生率100％，1例患者并发抗利尿激素分泌异常综合征 结果 根据血钠水平,经采用控制每日水量、补钠治疗5－14天后，23例均治愈,血钠平均恢复至138(135－142)mmol/l,血浆渗透压、尿钠均正常.结论 低钠血症是颈髓损伤后极为常见的并发症，但并发抗利尿激素分泌异常综合征十分少见；机体内抗利尿激素不适当分泌，导致的稀释性低钠血症可能是颈髓损伤继发低钠血症的发生机制之一。严格控制入液量及补钠为主要治疗方法.

Diagnosis and Treatment of water electrolyte imbalance in cervical spinal cord injury.

Abstract：Objective To investigate the clinical characters of water electrolyte imbalance in cervical spinal cord injury(CSCI) and the strategy diagnosis and treatment Methods There were 30 cases of CSCI(including 15 complete injury and 15 incomplete)， The blood pressure, heart rate, blood electrolyte concentration(sodium, kalium ),volume of 24 hours urine and sodium excretion ,plasma osmotic pressure were measured Hyponatremia occurred in 23 patients, and the morbidity was 100% in 15 cases of complete injury 1 case was diagnosed syndrome of inappropriate secretion of antidiuretic hormone(SIADH). Results Treatment included restrain of fluid inputting and sodium complementing according to the serum sodium concentration plasma osmotic and 24 hours urine and sodium excretion were return to nomalrange after 5 to 14 days of treatment. conclusion Electrolyte imbalance is a very common complication in CSCI, but SIADH is rare , and the diluted hyponatremia caused by the inappropriate sectretion of antidiuretio hormone may be one of its mechanism,the specific pathogenesis of hyponatremia of acute CSCI requires early diagnosis leading to the subsequent treatment.