急性頸脊髓損傷繼發(fā)低鈉血癥的臨床分析
發(fā)布時(shí)間：2018-07-21 12:45
【摘要】：目的分析總結(jié)急性頸髓損傷后低鈉血癥的臨床特征,并探究其發(fā)生的相關(guān)影響因素,可能的發(fā)生機(jī)制和治療方式。方法研究對(duì)象為2013年1月~2016年5月我院骨科收治的頸椎外傷患者,排除嚴(yán)重影響水鈉代謝的基礎(chǔ)疾病以及合并顱腦外傷、胸腹部嚴(yán)重多發(fā)傷等重要臟器損傷后的頸脊髓損傷患者210例,頸髓損傷程度按美國(guó)脊髓損傷協(xié)會(huì)(ASIA)分級(jí):完全性損傷28例(A級(jí)),不完全性損傷182例,其中B級(jí)18例,C級(jí)89例,D級(jí)75例;而選擇頸椎外傷未并存頸髓損傷患者47例為對(duì)照組。動(dòng)態(tài)監(jiān)測(cè)血清鈉、鉀、氯、血清白蛋白等生化指標(biāo),血紅蛋白、紅細(xì)胞比容等血液細(xì)胞學(xué)指標(biāo),以及血壓、心率,并獲取所有數(shù)據(jù)。用單因素和多因素Logistic回歸模型分析低鈉血癥的影響因素。并且根據(jù)監(jiān)測(cè)結(jié)果和治療反應(yīng)對(duì)低鈉血癥的發(fā)生機(jī)制及治療方法進(jìn)行分析。結(jié)果115例急性頸髓損傷患者發(fā)生低鈉血癥(54.76%),其中56例130"f血鈉135mmol/L即輕度低鈉血癥,50例120"f血鈉130mmol/L即中度低鈉血癥,9例血鈉120mmol/L即重度低鈉血癥;完全性損傷26例(92.86%),不完全性損傷89例(48.9%),其中B級(jí)83.33%(15/18),C級(jí)59.55%(53/89),D級(jí)28%(21/75)。對(duì)照組有3例患者發(fā)生血鈉降低(6.38%),全為輕度低鈉血癥;頸髓損傷患者血鈉均值(133.01±6.60)mmol/L,其中完全性損傷組(127.04±5.66)mmol/L,不完全性損傷組(133.92±6.26)mmol/L,均低于對(duì)照組(P0.01),且兩者之間差異顯著(P0.01)。頸髓損傷患者的血壓、心率、血紅蛋白以及紅細(xì)胞比容與對(duì)照組比較,均存在明顯差異,并且完全性頸髓損傷與不完全性損傷組之間也具有明顯差異。單因素分析結(jié)果顯示年齡、性別、脊髓損傷平面,甲強(qiáng)龍沖擊以及血鉀與低鈉血癥無(wú)明顯相關(guān)關(guān)系,而脊髓損傷程度、合并感染、低蛋白血癥、氣管切開、紅細(xì)胞比容以及血紅蛋白是低鈉血癥非常顯著的因素(P0.05);然而多因素分析結(jié)果提示僅由兩個(gè)明確影響因素保留在Logistic回歸模型中,分別是脊髓損傷程度,合并感染(P0.05)。結(jié)論低鈉血癥是常繼發(fā)于頸脊髓損傷,發(fā)生率較高,其影響因素較多。頸髓嚴(yán)重?fù)p傷、合并感染是頸髓損傷患者發(fā)生低鈉血癥的主要危險(xiǎn)因素�；颊哳i髓損傷程度越嚴(yán)重,往往血鈉降低程度也十分嚴(yán)重。頸髓損傷后體內(nèi)抗利尿激素(ADH)異常分泌,引起的低滲透性或高血容量性低鈉血癥也許為頸脊髓損傷繼發(fā)低鈉血癥的主要發(fā)生機(jī)制之一�？刂蒲a(bǔ)液量和適度補(bǔ)鈉是低鈉血癥安全有用的治療措施。臨床醫(yī)師應(yīng)著重關(guān)注頸髓損傷嚴(yán)重患者血鈉情況,并積極預(yù)防感染,降低患者低鈉血癥發(fā)生率。
[Abstract]:Objective to analyze and summarize the clinical features of hyponatremia after acute cervical spinal cord injury, and to explore the related factors, possible mechanism and treatment of hyponatremia. Methods from January 2013 to May 2016, patients with cervical vertebra trauma treated in orthopedic department of our hospital were excluded from the basic diseases which seriously affected the metabolism of water and sodium and the patients with craniocerebral trauma. There were 210 cases of cervical spinal cord injury after severe multiple trauma of chest and abdomen. According to the American Association of Spinal Cord injury (Asia), the degree of cervical spinal cord injury was 28 cases of complete injury (Grade A) and 182 cases of incomplete injury. Among them, 18 cases were grade B, 89 cases were grade C and 75 cases were grade D, while 47 cases of cervical spinal cord injury without cervical spinal cord injury were selected as control group. Dynamic monitoring of serum sodium, potassium, chlorine, serum albumin and other biochemical indicators, hemoglobin, erythrocyte volume and other blood cytological indicators, as well as blood pressure, heart rate, and to obtain all the data. Univariate and multivariate logistic regression models were used to analyze the influencing factors of hyponatremia. The mechanism and treatment of hyponatremia were analyzed according to the monitoring results and therapeutic responses. Results among 115 patients with acute cervical spinal cord injury, hyponatremia occurred (54.76%). Among them, 56 (130 "f) had 135mmol / L of blood natrium (50 cases) with mild hyponatremia (50 cases) with 120" F "serum natrium 130 mmol / L (9 cases with moderate hyponatremia) with 120 mmol / L of serum sodium and 9 cases with severe hyponatremia. There were 26 cases of complete injury (92.86%) and 89 cases of incomplete injury (48.9%). Among them, B grade was 83.33% (15 / 18), C grade was 59.55% (53 / 89) and D grade was 28% (21 / 75). In the control group, the blood sodium decreased (6.38%) and the mean value of serum sodium was (133.01 鹵6.60) mmol / L in the patients with cervical spinal cord injury, in which the complete injury group (127.04 鹵5.66) mmol / L and the incomplete injury group (133.92 鹵6.26) mmol / L were lower than the control group (P0.01), and the difference between the two groups was significant (P0.01). There were significant differences in blood pressure, heart rate, hemoglobin and erythrocyte volume between the patients with cervical spinal cord injury and the control group, and there was also significant difference between the complete cervical spinal cord injury group and the incomplete injury group. Univariate analysis showed that age, sex, spinal cord injury level, methylenolone shock and serum potassium were not significantly correlated with hyponatremia, while spinal cord injury degree, co-infection, hypoproteinemia, tracheotomy, RBC volume and hemoglobin were very significant factors of hyponatremia (P0.05); however, the results of multivariate analysis showed that only two definite influencing factors remained in Logistic regression model, which were the degree of spinal cord injury and co-infection (P0.05). Conclusion hyponatremia is often secondary to cervical spinal cord injury with a high incidence and many influencing factors. Severe cervical spinal cord injury and complicated infection are the main risk factors for hyponatremia in patients with cervical spinal cord injury. The more severe the cervical spinal cord injury, the more serious the decrease in blood sodium. Hypotonic or hypervolemic hyponatremia caused by abnormal secretion of ADH after cervical spinal cord injury may be one of the main mechanisms of hyponatremia secondary to cervical spinal cord injury. Control of fluid rehydration and moderate sodium supplementation are safe and useful therapeutic measures for hyponatremia. Clinicians should pay more attention to blood sodium in patients with severe cervical spinal cord injury, and actively prevent infection and reduce the incidence of hyponatremia.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R651.2
本文編號(hào)：2135571
[Abstract]:Objective to analyze and summarize the clinical features of hyponatremia after acute cervical spinal cord injury, and to explore the related factors, possible mechanism and treatment of hyponatremia. Methods from January 2013 to May 2016, patients with cervical vertebra trauma treated in orthopedic department of our hospital were excluded from the basic diseases which seriously affected the metabolism of water and sodium and the patients with craniocerebral trauma. There were 210 cases of cervical spinal cord injury after severe multiple trauma of chest and abdomen. According to the American Association of Spinal Cord injury (Asia), the degree of cervical spinal cord injury was 28 cases of complete injury (Grade A) and 182 cases of incomplete injury. Among them, 18 cases were grade B, 89 cases were grade C and 75 cases were grade D, while 47 cases of cervical spinal cord injury without cervical spinal cord injury were selected as control group. Dynamic monitoring of serum sodium, potassium, chlorine, serum albumin and other biochemical indicators, hemoglobin, erythrocyte volume and other blood cytological indicators, as well as blood pressure, heart rate, and to obtain all the data. Univariate and multivariate logistic regression models were used to analyze the influencing factors of hyponatremia. The mechanism and treatment of hyponatremia were analyzed according to the monitoring results and therapeutic responses. Results among 115 patients with acute cervical spinal cord injury, hyponatremia occurred (54.76%). Among them, 56 (130 "f) had 135mmol / L of blood natrium (50 cases) with mild hyponatremia (50 cases) with 120" F "serum natrium 130 mmol / L (9 cases with moderate hyponatremia) with 120 mmol / L of serum sodium and 9 cases with severe hyponatremia. There were 26 cases of complete injury (92.86%) and 89 cases of incomplete injury (48.9%). Among them, B grade was 83.33% (15 / 18), C grade was 59.55% (53 / 89) and D grade was 28% (21 / 75). In the control group, the blood sodium decreased (6.38%) and the mean value of serum sodium was (133.01 鹵6.60) mmol / L in the patients with cervical spinal cord injury, in which the complete injury group (127.04 鹵5.66) mmol / L and the incomplete injury group (133.92 鹵6.26) mmol / L were lower than the control group (P0.01), and the difference between the two groups was significant (P0.01). There were significant differences in blood pressure, heart rate, hemoglobin and erythrocyte volume between the patients with cervical spinal cord injury and the control group, and there was also significant difference between the complete cervical spinal cord injury group and the incomplete injury group. Univariate analysis showed that age, sex, spinal cord injury level, methylenolone shock and serum potassium were not significantly correlated with hyponatremia, while spinal cord injury degree, co-infection, hypoproteinemia, tracheotomy, RBC volume and hemoglobin were very significant factors of hyponatremia (P0.05); however, the results of multivariate analysis showed that only two definite influencing factors remained in Logistic regression model, which were the degree of spinal cord injury and co-infection (P0.05). Conclusion hyponatremia is often secondary to cervical spinal cord injury with a high incidence and many influencing factors. Severe cervical spinal cord injury and complicated infection are the main risk factors for hyponatremia in patients with cervical spinal cord injury. The more severe the cervical spinal cord injury, the more serious the decrease in blood sodium. Hypotonic or hypervolemic hyponatremia caused by abnormal secretion of ADH after cervical spinal cord injury may be one of the main mechanisms of hyponatremia secondary to cervical spinal cord injury. Control of fluid rehydration and moderate sodium supplementation are safe and useful therapeutic measures for hyponatremia. Clinicians should pay more attention to blood sodium in patients with severe cervical spinal cord injury, and actively prevent infection and reduce the incidence of hyponatremia.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R651.2
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