刘英杰 谭旭宏

【摘要】 目的：观察颈髓损伤后出现尿崩症的临床特点，并探讨右美托咪定在脊髓损伤术后应用的诊治要点，总结临床经验，以提高救治水平。方法：对收治的颈髓损伤后出现尿崩症（DI）1例进行临床观察及资料收集和整理分析。结果：本例患者颈5椎体爆裂性骨折脱位并颈髓损伤，行前路颈5椎体次全切、脊髓减压、椎管擴大成形修复术，术后持续高热、尿崩，垂体后叶素联合右美托咪定静脉泵入，1周后，体温正常、尿量明显减少。结论：对于脊髓损伤术后患者，小剂量右美托咪定的使用可稳定血流动力学，并对尿崩症有治疗作用。

【关键词】 右美托咪定;颈髓损伤;尿崩症

Application of Dexmedetomidine in Diabetes Insipidus with Cervical Spinal Cord Injury and Literature Review

Liu Yingjie1，Tan Xuhong2

1.Guizhou University of Chinese Medicine， Guiyang，Guizhou 550002;

2.Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine， Guiyang， Guizhou 550002

[Abstract] Objective：To observe the clinical characteristics of diabetes insipidus after cervical spinal cord injury， and to explore the diagnosis and treatment of dexmedetomidine after spinal cord injury， summarize the clinical experience， in order to improve the treatment level. Methods： A case of diabetes insipidus （DI） after cervical spinal cord injury was observed and analyzed. Results： In this case， the cervical spinal cord was injured due to the dislocation of a burst fracture of the 5th cervical vertebra. The patient underwent anterior resection of the 5th cervical vertebra 、spinal cord decompression 、expanded vertebral canal reconstruction. After the surgery， the patient sustained high fever and diabetes insipidus. Conclusion： For patients with spinal cord injury after surgery， small dose of dexmedetomidine can stabilize hemodynamics and has therapeutic effect on diabetes insipidus.

[Key words]Dexmedetomidine; Cervical spinal cord injury; Diabetes insipidus

颈椎骨折可直接损伤颈髓，颈髓损伤合并尿崩症已备受临床关注，如尿崩症处理不当，可致电解质紊乱和酸碱平衡失调，容易使颈脊髓损伤病情加重，甚至危及患者生命。但目前颈髓损伤致尿崩症的发病机制尚未明确，因而对尿崩症的治疗亦不尽相同，如非抗利尿激素（ADH）类抗利尿药物治疗、ADH类激素替代治疗、高压氧治疗等。右美托咪定作为中枢a2肾上腺能受体激动剂，可抑制交感神经活动，小剂量右美托咪定的使用可稳定血流动力学，并对尿崩症有一定治疗作用。目前作者所在医院运用右美托咪定治疗颈椎骨折脱位颈髓损伤合并尿崩症1例患者，疗效满意。现报告如下。

1病历资料

患者女性，谭某某，39岁。因车祸致颈部疼痛、四肢无力18d就诊。18d前患者因车祸致颈部疼痛……