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医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:

31卷

期数:

2018年03期

页码:

73-77

栏目:

论著

出版日期:

2018-02-01

文章信息/Info

Title:

Effect of Natriuremia and Blood Sodium Fluctuation on Prognosis of Patients with Aneurysm Subarachnoid Hemorrhage

文章编号:

1006-1959（2018）03-0073-05

作者:

石 油; 朱 继

重庆医科大学附属第一医院神经外科，重庆 400016

Author(s):

SHI You; ZHU Ji

Department of Neurosurgery,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China

关键词:

动脉瘤性蛛网膜下腔出血; 血钠波动; 低钠血症; Rankin修订量表评分

Keywords:

Aneurysm subarachnoid hemorrhage; Blood sodium fluctuation; Hyponatremia; Rankin revised scale score

分类号:

R743.35

DOI:

10.3969/j.issn.1006-1959.2018.03.023

文献标志码:

A

摘要:

目的 观察动脉瘤性蛛网膜下腔出血（aSAH）中低钠血症与血钠波动的特点，分析低钠血症与钠波动的关系及对预后的影响。方法 回顾性分析重庆医科大学附属第一医院2017年1月~8月收治的189例aSAH病例，根据血钠波动最大值，分为＜6 mmol/L，6~12 mmol/L，＞12 mmol/L三组，以Rankin修订量表评分（mRS）评估患者预后，使用Logistic回归分析血钠波动与患者预后的联系。结果 mRS≥4组的患者发病后入院时间间隔短于mRS≤1组，mRS≥4组的患者鞍上池出血区域CT值均值最高，差异有统计学意义（P＜0.05）。患有糖尿病和高血压的患者预后差，Fisher分级为Ⅲ~Ⅳ级的患者较Ⅰ~Ⅱ级的预后差，差异有统计学意义（P＜0.01）。发生位置在后循环的患者比颈内动脉段预后较差，差异有统计学意义（P＜0.05）。低钠血症与不良的神经功能预后相比，差异无统计学意义（P＞0.05）。每日钠波动6~12 mmol/L组中，mRS≤1者26例（31.71%），2≤mRS≤3者25例（30.49%），mRS≥4者31例（37.80%）；＞12mmol/L组中mRS≤1者1例（6.67%），2≤mRS≤3者2例（13.33%），mRS≥4者12例（80.00%）。病程中血钠波动6~12 mmol/L及＞12 mmol/L组，较＜6 mmol/L组患者mRS评分更高，预后更差，差异具有统计学意义（P＜0.05）。结论 aSAH患者中，血钠的波动，而非低血钠本身，与不良神经功能预后有统计学关联，这与现行的理念存在冲突，有待更进一步的临床探索。

Abstract:

Objective To observe the characteristics of hyponatremia and blood sodium fluctuation in patients with aneurysm subarachnoid hemorrhage(aSAH),and to analyze the relationship between hyponatremia and sodium fluctuation and its influence on prognosis.Methods A total of 189 cases of aSAH admitted from January to August 2017 in the first affiliated Hospital of Chongqing Medical University were retrospectively analyzed.According to the maximum fluctuation of blood sodium,they were divided into three groups,＜6 mmol/L，6~12 mmol/L，and ＞12 mmol/L.The prognosis of the patients was evaluated by the revised Rankin scale score (mRSs),logistic regression analysis was used to analyze the relationship between serum sodium fluctuation and prognosis.Results The interval of admission in mRS≥4 group was shorter than that in mRS≤1 group.The mRS 4 group had the highest mean CT value in the hemorrhage area of suprasellar cistern,and the difference was statistically significant(P<0.05).The prognosis of patients with diabetes mellitus and hypertension was worse than that of patients with grade Ⅰ~Ⅱ with Fisher grade Ⅲ~Ⅳ.The difference was statistically significant(P<0.01).The prognosis of the patients with posterior circulation was worse than that of the internal carotid artery segment.The difference was statistically significant(P<0.05).There was no significant difference between hyponatremia and poor prognosis of neurological function(P>0.05).The daily sodium fluctuation in 6~12 mmol/L group,mRS≤1 in 26 cases(31.71%),2≤mRS≤3 in 25 cases(30.49%),mRS≥4 in 31 cases(37.80%);>12mmol/L group,mRS≤1 in 1 case(6.67%),2≤mRS≤3 in 2 cases (13.33%)and mRS≥4 in 12 cases(80.00%).Serum sodium fluctuated between 6 and 12 mmol/L and>12 mmol/L during the course of the disease,with a higher mRS score and a poorer prognosis than the 6 mmol/L group.The difference was statistically significant(P<0.05).Conclusion In patients with aSAH, fluctuations in serum sodium,but not in hyponatremia, are statistically associated with poor prognosis of neurological function.This conflicts with the current concept and needs further clinical exploration.

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更新日期/Last Update: 2018-02-01