急性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病因、发病机制、诊断和治疗。方法]回顾性分析2004年-2006年收治的急性颈髓损伤后低钠血症患者15例的临床资料。结果]全组患者入院24—72h内血钠低于130mmol／L，其中5例低于120mmol／L。14例尿钠40—68mmol／L，1例尿钠为148mmol／L；尿渗透压420～980mmol／L，12例患者经适当的补盐和限制水摄入量治疗，低钠症状2～3周内改善；2例发热患者因发热不能严格限制水摄入，其中1例2个月后恢复，另1例失访；1例患者补盐限水后病情加重，调整治疗方案后恢复。结论]颈髓损伤越重，损伤后低钠血症发生率越高；颈髓损伤后低钠血症多由抗利尿激素分泌异常综合征引起；血钠浓度，血、尿渗透压等是诊断依据；适当补充钠盐和液体量是有效的治疗方法。

Hyponatremia after acute cervical spinal cord injury

Objective]To investigate the pathogenesis,pathology,diagnosis and therapy of hyponatremia after acute spinal cord injury.Method]Fifteen in-patients with hyponatremia after acute spinal cord injury from 2004 to 2006 were retrospectively analyzed.Result]Serum sodium was lower than 130 mmol/L in all cases.Urine sodiumcanned was from 40 to 68 mmol/L and urine osmotic pressure was from 420 to 980 mmol/L.After limitation of water intake and appropriate salt intake,12 patients recovered at 2 to 3 weeks.Because of fever and avoiding limitation of water intake,the other 3 patients recovered slowly.Conclusion]The more serious the acute spinal cord injury,the higher the frequency of hyponatremia;syndrome of inappropriate antidiuretic hormone secretion(SIADH) is its primary cause: appropriate measures should be taken to correct the hyponatremia according to the findings of serum sodium and urine osmotic pressure.