颈髓损伤后的低钠血症

目的探讨急性颈髓损伤后低钠血症的发病机制和治疗方法。方法回顾性分析2002年2月至2007年10月收治的13例颈髓损伤患者的临床资料。结果13例颈髓损伤患者中7例出现不同程度的低钠血症,均为FrankelA～B级患者。同期胸腰椎病变(骨折、结核等)所致脊髓损伤病例13例(按Frankel分级均为C～D级),无1例发生低钠血症。经高渗盐溶液补钠,适当补充胶体液1～2周后血钠水平恢复满意。结论低钠血症是急性颈髓损伤后常见的并发症,颈髓损伤程度越重,低钠血症发生率越高。其发生机制可能与颈髓损伤后交感神经系统受抑制,血管紧张素Ⅱ、醛固酮分泌减少有关。大量补钠、补液可纠正低钠血症,补充适当的胶体液有利于加快血钠水平的恢复。

Hyponatremia after acute cervical spinal cord injury

Objective To investigate the pathogenesis and therapeutics of hyponatremia after acute cervical spinal cord injury.Methods The clinical data of 13 inpatients with acute cervical cord injury from Feb 2002 to Oct 2007 was retrospectively analyzed.Results In 13 patients with acute cervical cord injury,7 patients underwent different degree of hyponatremia(Frankel grading:grade A to B).By comparison,none underwent hyponatremia in 13 cases with acute spinal cord injury due to thoracic vertebral or lumbar vertebral disease(fracture,tuberculosis for instance)(Frankel grading:grade C to D).Serum sodium recovered to a satisfying level after 1 to 2 weeks' therapy with hypertonic saline solution and colloid liquor properly.Conclusion Acute cervical spinal cord injury is commonly complicated by hyponatremia.The more serious of acute cervical cord injury,the more frequent of hyponatremia.Hyponatremia may partly be due to the inhibition of sympathetic nerve system,and less secretion of angiotensinⅡand aldosterone.It can be retrieved by addition of adequate hypertonic salt and water.Proper supply of colloid liquor is beneficial to the recovery of serum sodium level.