急性颈脊髓损伤继发低钠血症影响因素分析

摘要

Objective To observe clinical features of hyponatremia after acute cervical spinal cord injury(CSCI), and to analyze its possible influencing factors.Methods 210 patients with CSCI caused by cervical vertebras trauma were selected(including 28 complete injury and 182 incomplete) and 47 cases of controls were selected.The univariate and multivariate Logistic regression model were used to analyzed the influencing factors.Results 115 cases of acute cervical spinal cord injury patients with hyponatremia (54.76%), of which 26 cases of complete injury (92.86%), incomplete injury in 89 cases (48.9%), significantly higher than the control group (6.38%).The concentration of serum sodium was lower in the CSCI group than that in the control group(P<0.05).The serum sodium of patients with complete CSCI and with incomplete CSCI had significant difference(P<0.01).Severity of CSCI, associated infection, hypoproteinemia, tracheotomy, hemoglobin and hematocrit were shown to be highly significant factors for hyponatremia from the univariate analysis.The multivariate analysis revealed that severity of CSCI and associated infection were potential influencing factors for hyponatremia after CSCI.Conclusion Hyponatremia is a very common complication in CSCI.The severity of spinal cord injury and associated infection are risk factors for hyponatremia, and the severity of hyponatremia is related to injury extent.To reduce the morbidity of hyponatremia, clinicians should focus on the case of hyponatremia in patients with severe CSCI, and actively prevent infection.%目的 分析急性颈髓损伤后低钠血症的临床特征,并探讨其发生的相关影响因素.方法 抽取颈髓损伤患者210例, 颈髓损伤程度按美国脊髓损伤协会(ASIA)分级:完全性损伤28例(A级),不完全性损伤182例,其中B级18例,C级89例,D级75例;另选择颈椎外伤未并存颈髓损伤患者47例为对照组.用单因素和多因素Logistic回归模型分析低钠血症的影响因素.结果 115例急性颈髓损伤患者发生低钠血症(54.76%),其中完全性损伤26例(92.86%),不完全性损伤89例(48.9%),明显高于对照组(6.38%).颈髓损伤患者的血钠低于对照组(P<0.05),并且完全性损伤与不完全性损伤,两组间的差异有统计学意义(P<0.01).单因素Logistic回归分析指出低钠血症与颈髓损伤程度、合并感染、低蛋白血症、气管切开、红细胞比容以及血红蛋白有关.多因素Logistic回归分析显示低钠血症与颈髓损伤程度以及合并感染具有明显相关性.结论 低钠血症是颈脊髓损伤后常见并发症,发生率较高,颈髓严重损伤、合并感染是颈髓损伤患者发生低钠血症的主要危险因素.患者颈髓损伤程度越严重,往往低钠血症程度也十分严重.临床医师应着重关注颈髓损伤严重患者血钠情况,并积极预防感染,降低患者低钠血症发生率.