摘要
目的探讨急性颈脊髓损伤并发抗利尿激素分泌异常综合征（syndrome of inappropriate secretion of antidiuretic hormone,SIADH）的临床特征、诊断和治疗方法。方法回顾分析25例急性颈脊髓损伤并发SIADH病例的临床资料。结果全组血钠均低于130 mmol/L,血浆渗透压为204-268 mmol/L,尿渗透压为489-660 mmol/L,尿钠为88-139.5 mmol/L。25例均出现不同程度的头痛、恶心等症状,但无脱水表现。16例（轻中度）经限制液体入量补钠治疗后血钠逐步上升;9例（重症）经严格限水补钠,血钠恢复缓慢。12例伤后3-7 d进行手术治疗,术后继续严格限水补钠,血钠恢复时间平均为10 d左右。结论伤后血钠、血浆渗透压、尿渗透压和尿钠是颈脊髓损伤并发SIADH的重要诊断依据;早期诊断、严格限制液体入量、补钠等非常重要。早期手术治疗可能有助于缩短病程。
Objective To investigate the clinical characteristics, diagnosis and treatment of syndrome of inappropriate secretion of antidiuretic hormone （SIADH） after acute cervical spinal cord injury （ACSCI）. Methods Twenty-five patients with SIADH after ACSCI were retrospectively analyzed. Results All serum sodium was lower than 130 mmol/L（ranged from 116 to 128 mmol/L. Plasma osmotic pressure ranged from 204 to 268 mmol/L. Urine sodium ranged from 88 to 139.5 mmol/L and urine osmotic pressure ranged from 489 to 660 mmol/L. Symptoms of 25 cases varied from mild headache, nausea and vomiting, even coma, but without dehydration appearance. After limitation of water intake and appropriate salt intake, 16 cases of mild hyponatremia recovered after 2 to 3 weeks, but 9 eases of severe hyponatremia （were complete spinal cord injury）recovered slowly. Twelve cases that underwent operations 3 to 7 d post-injury recovered within to d postoperation. Conclusion During the early post-injury period, the patient＇ s sodium level of serum and urine, osmotic pressure of serum and urine, are important for diagnosis. It is important to early diagnosis, fluid restriction, sodium complementing and adjustment of fluid intakes depending on serum sodium level. Operation undertaken in early stage might reduce the course of disease.
出处
《脊柱外科杂志》
2008年第5期271-273,共3页
Journal of Spinal Surgery
关键词
颈椎
脊髓损伤
低钠血症
ADH分泌不当综合征
Cervical vertebrae
Spinal cord injuries
Hyponatremia
Inappropriate ADH syndrome
