动脉瘤性蛛网膜下腔出血后低钠血症发生率的分析及治疗

Treatment and analysis of hyponatremiain patients with aneurysmal subarachnoid hemorrhage

目的研究颅内动脉瘤破裂出血后低钠血症的发生率同Fisher分级和脑血管痉挛的关系。方法2003年1月至2005年12月动脉瘤性蛛网膜下腔出血(SAH)患者320例,按解剖部位分成大脑前及前交通(ACA&ACoA)、后交通(PCoA)和大脑中动脉(MCA)三组,分析其低钠血症的发生率。结果动脉瘤性SAH低钠血症总的发生率约为29.7%,ACA&ACoA、PCoA、MCA三组低钠血症的发生率分别约为47.9%、15.2%和16.2%,重度低钠血症的发生率分别为35.0%、7.1%和7.4%。ACA&ACoA组中Fisher分级Ⅲ～Ⅳ级和Ⅰ～Ⅱ级低钠血症的发生率分别为66.7%和14.0%;有脑血管痉挛和无脑血管痉挛者低钠血症的发生率分别为73.1%和16.1%。结论ACA&ACoA组低钠血症与重度低钠血症的发生率明显高于PCoA组和MCA组,ACA&AcoA组中Fisher分级Ⅲ～Ⅳ级或并发脑血管痉挛的患者低钠血症的发生率明显增高,临床应注意监测并及时纠正。

Objective To investigate the prevalence of hyponatremia in patients with Aneurysmal Subarachnoid Hemorrhage and analyse the frequency of hyponatremia with ruptured intracranial aneurysm and their correlation with Fisher grading and cerebral vasospasm. Methods 320 patients from January 2003 to December 2005 were divided into three groups based on the location of the aneurysms. Patients with anterior carotid artery and anterior communicating artery（ACA＆ACoA） aneurysm group, with posterior communicating artery（PCoA） aneurysm group and middle carotid artery （MCA） aneurysm group. The prevalence of hyponatremia was analyzed respectively. Results The total prevalence of hyponatremia with aneurysmal SAH was about 29.7%. For three groups of patients with prevalence aneurysm, the prevalence of hyponatremia was 47.9%, 15.2% and 16.2% and the frequency of severe hyponatremia was 35.0%, 7.1% and 7.4% respoctively. Among the ACA＆ACoA group, the prevalence of hyponatremia in Fisher grade Ⅲ～Ⅳ and Ⅰ～Ⅱ was 66.7% and 14.0%; the prevalence of hyponatremia with and without vasospasm was 73.1% and 16.1%. Conclusions The ACA＆A-CoA group a significantly higher prevalence of hyponatremia and severe hyponatremia than other groups. Among the A-CA＆ACoA group, hyponatremia occures significantly more frequently in Fisher grade Ⅲ～Ⅳ cases as in vasospasm cases. Patients with ruptured ACA＆ACoA aneurysm should be carefully observed and treated as soon as possible.