CAJ | 학술논문

目的分析急性颈脊髓损伤 (acute cervical spinal cord injury,ACSCI) 后低蛋白血症(hypoproteinemia)的发生机制,探讨其临床特点,以及预防与治疗低蛋白血症的有效方法. 方法回顾总结分析了2012年6月-2014年3月济南军区总医院脊髓修复科145例ACSCI患者的发生低蛋白血症的临床特点. 将纳入病例分为老年组(≥60岁)65例,中青年组(<60岁)80例两组;肺部感染气管切开组(80例)、无肺部感染气管未切开组(65例);完全性损伤组110例、不完全损伤组35例;C2~C3组20例,C4~C5组85例;C6~C7组40例,其中气管切开组与未切开组行以下检测:每3d抽血复查肝肾功等必要指标,分析两组患者入院后患者的血清白蛋白的变化趋势,以及何时给予患者静脉输注白蛋白最为有效,入院后均给予静脉滴注白蛋白及肠内营养,并鼓励患者尽早行自主进食.应用 SPSS15.0软件进行统计学分析,t检验进行组间和组内比较,P<0.05时差异有统计学意义.结果入院时各组间差异无统计学意义(P>0.05). C4~C5节段的颈脊髓损伤发生低蛋白血症的概率要明显高于其他节段;完全性颈脊髓损伤发生低蛋白血症的概率要远远高于不完全颈脊髓损伤. 肺部感染是诱发低蛋白血症的一个重要因素. 入院前18 d,两组间差异有统计学意义(P<0.05). 两组白蛋白指标变化趋势大致相同. 结论急性颈脊髓损伤后血清白蛋白迅速降低,临床中治疗纠正困难,治疗中的激素冲击治疗、并发的感染等诸多因素均可加重低蛋白血症; 颈脊髓损伤导致的低蛋白血症而无法进食的患者应立即给予营养支持及静脉滴注足量的人血白蛋白,可有效降低低蛋白血症的发生,肺部感染会加重低蛋白血症.
목적 분석급성경척수손상 (acute cervical spinal cord injury,ACSCI) 후저단백혈증(hypoproteinemia)적발생궤제,탐토기림상특점,이급예방여치료저단백혈증적유효방법. 방법 회고총결분석료2012년6월-2014년3월제남군구총의원척수수복과145례ACSCI환자적발생저단백혈증적림상특점. 장납입병례분위노년조(≥60세)65례,중청년조(<60세)80례량조;폐부감염기관절개조(80례)、무폐부감염기관미절개조(65례);완전성손상조110례、불완전손상조35례;C2~C3조20례,C4~C5조85례;C6~C7조40례,기중기관절개조여미절개조행이하검측:매3d추혈복사간신공등필요지표,분석량조환자입원후환자적혈청백단백적변화추세,이급하시급여환자정맥수주백단백최위유효,입원후균급여정맥적주백단백급장내영양,병고려환자진조행자주진식.응용 SPSS15.0연건진행통계학분석,t검험진행조간화조내비교,P<0.05시차이유통계학의의.결과 입원시각조간차이무통계학의의(P>0.05). C4~C5절단적경척수손상발생저단백혈증적개솔요명현고우기타절단;완전성경척수손상발생저단백혈증적개솔요원원고우불완전경척수손상. 폐부감염시유발저단백혈증적일개중요인소. 입원전18 d,량조간차이유통계학의의(P<0.05). 량조백단백지표변화추세대치상동. 결론 급성경척수손상후혈청백단백신속강저,림상중치료규정곤난,치료중적격소충격치료、병발적감염등제다인소균가가중저단백혈증; 경척수손상도치적저단백혈증이무법진식적환자응립즉급여영양지지급정맥적주족량적인혈백단백,가유효강저저단백혈증적발생,폐부감염회가중저단백혈증.
Objective To analyse hypoalbuminemia (Hypoproteinemia) mechanism following acute cervical spinal cord injury(acute cervical spinal cord injury,ACSCI),and to discuss its clinical features,as well as effective prevention and treatment methods. Methods The changes in the characteristics of 145 cases of spinal cord repair ACSCI patient's blood albumin from June 2012 to March 2014 in the General Hospital of Jinan military region. The older group included 65 patients grouped into (≥60 years old) the young group (<60 years,80 cases);lung infection tracheotomy group (80 cases),no lung infection trachea uncut group (65 cases);110 cases were of completely injury group,35 patients incomplete injury;C2-C3 group of 20 cases,C4-C5 group of 85 cases;C6-C7 group of 40 cases who underwent the following tests:after admission were given with intravenous albumin and intestinal nutrition as early as possible and were encouraged self-feeding,blood was sampled every three days to be reexamination such as liver and kidney function indicators so as to analyze their serum albumin trends and to judge when to give the patient an intravenous infusion of albumin most effectively. SPSS15.0 software was applied for statistical analysis,t test was used in comparison inter- and intra- groups,P<0.05 when the difference was statistically significant. Results Differences of inter- groups was not statistically significant at admission(P>0.05). In cervical spinal cord C4-C5 segments injury the incidence of low protein was significantly higher than other segments;in complete cervical spinal cord injury hypoproteinemia possibility was much higher than the incomplete cervical spinal cord injury. Lung infection inducing hypoalbuminemia was an important factor. 18 d,before admission,there were significant differences between both groups (P<0.05). Both's albumin index roughly was of the same trend. Conclusion Serum albumin after acute cervical spinal cord injury decreases rapidly,clinical treatment to correct it is of the difficulties;the impact of hormone therapy in the treatment of concurrent infections,and many other factors can all aggravate hypoalbuminemia;the patients with low protein induced by cervical spinal cord injury who can not eat immediately are given timely and adequately amounts of nutritional support as well as human serum albumin infusion which could effectively reduce the incidence of hypoal-buminemia;lung infections could aggravete hypoproteinemia.