McKee A C, Winkelman M D, Banker B Q
Department of Pathology (Neuropathology), Cleveland Metropolitan General Hospital, OH.
Neurology. 1988 Aug;38(8):1211-7. doi: 10.1212/wnl.38.8.1211.
The rapid correction or over-correction of hyponatremia is believed by many to be the crucial factor in the causation of central pontine myelinolysis (CPM). Over a 17-year period we found CPM in 10 (7%) of the 139 burn patients examined postmortem but in only 10 (0.28%) of the 3,528 patients in the general autopsy population (p less than 0.001). Each of the burn patients with CPM had suffered a prolonged, nonterminal episode of extreme serum hyperosmolality, whereas most burn patients without CPM had not suffered such an episode. The histologic age of the lesions correlated with the duration of time between the hyperosmolar episode and death. Hypernatremia, hyperglycemia, and azotemia, alone or combined, accounted for the hyperosmolality. No single electrolyte or metabolic derangement was essential, as in at least one burn patient with CPM the serum sodium, glucose, or blood urea nitrogen was normal during the hyperosmolar episode. Hyponatremia was not present in any burn patient with CPM. We conclude that severely burned patients, like alcoholics, are especially susceptible to CPM, and that in burn patients with CPM there is a striking association with serum hyperosmolality. The data also suggest that the rapid correction of hyponatremia exerts its effects by causing an osmotic shift and not because of any specific property of the sodium ion.
许多人认为，低钠血症的快速纠正或过度纠正，是导致中枢性桥脑髓鞘溶解症（CPM）的关键因素。在17年的时间里，我们在139例烧伤患者尸检中发现了10例（7%）CPM，但在3528例普通尸检人群中仅发现10例（0.28%）（p<0.001）。每例患有CPM的烧伤患者都经历过一段持续时间较长、并非终末期的严重血清高渗状态，而大多数未患CPM的烧伤患者并未经历过这种情况。病变的组织学年龄与高渗状态发作至死亡之间的时间长短相关。高钠血症、高血糖和氮质血症，单独或合并出现，均可导致高渗状态。没有任何一种单一的电解质或代谢紊乱是必不可少的，因为至少有一例患有CPM的烧伤患者在高渗状态发作期间血清钠、葡萄糖或血尿素氮是正常的。任何患有CPM的烧伤患者均未出现低钠血症。我们得出结论，严重烧伤患者与酗酒者一样，特别容易患CPM，而且在患有CPM的烧伤患者中，血清高渗状态与之存在显著关联。数据还表明，低钠血症的快速纠正通过引起渗透移位发挥作用，而非由于钠离子的任何特殊性质。
