急性颈髓损伤后抗利尿激素分泌异常综合征23例

目的探讨急性颈髓损伤后抗利尿激素分泌异常综合征(syndrome of inappropriate antidiuretic hormone secretion, SIADH)的病因、发病机制、诊断及治疗. 方法回顾性总结23例急性颈髓损伤后SIADH病人,其中男21例,女2例 .全组24 h血钠均＜130 mmol/L,其中5例血钠＜120 mmol/L.全组24 h尿钠38 ～62 mmol/L,尿渗透压420～970 mmol/L. 结果 20例经限制水摄入量和适量的补盐治疗,低钠症状3周内改善.3 例病人因发热、水摄入量限制不严格,恢复缓慢. 结论颈髓损伤程度越重,SIADH发生率越高;血钠越低,临床表现越严重、越复杂.低血钠、尿渗透压高于血浆渗透压、血容量增加及抗利尿激素(ADH)增高是急性颈髓损伤后SIADH的诊断依据.限制水摄入量和适当补盐是安全有效的治疗方法.

Syndrome of inappropriate antidiuretic hormone secretion after acute cervical sp inal cord injury

Objective To discuss the pathogenesis,pathology, diagnosis, and treatment of syndrome of inappropriate antidiuretic hormone (SIADH) after acute cervical spinal cord injury. Methods Of the 23 cases of SIADH, 21 were male and 2 female. All serum sodium was lower than 130 mmol/L. Urine sodium ranged from 38 to 62 mmol/L. Urine osmotic pressure ranged from 420 970 mmol/L. Results After limitation of water intake and appropriate salt in take, 20 patients were cured in 3 weeks. Three patients recovered slowly on account of fever and without strict limitation of water intake. Conclusions The more serious acute cervical spinal cord injury, the higher morbidity of SIADH has; the lower serum sodium, the more serious and complicated clinical manifestation will be. The rise of blood volume and antidiuretic hormone after acute cervical spinal cord injury is made up of the basis of the diagnosis of SIADH. Limitation of water intake and therapy of adding salt are safe and effective in the treatment of SIADH.