动脉瘤性蛛网膜下腔出血后水钠紊乱的临床特点及诊治

Clinical characteristics,diagnosis and treatment of water-sodium disturbance after aneurysmal subarachnoid hemorrhage

目的探讨动脉瘤性蛛网膜下腔出血(SAH)后水钠紊乱的临床特点及诊治方法。方法根据临床表现和实验室检查,将SAH后的水钠紊乱分为低钠血症、高钠血症和尿崩症三类,分析其临床特点和诊断标准;治疗根据实验室检查的指标及水钠紊乱处理的基本原则进行调整。结果全组均为水钠紊乱患者,其中低钠血症49例,高钠血症5例,尿崩症2例。出院时根据GOS评估法判定疗效:良好31例,中残14例,重残6例,植物生存2例,死亡3例。结论动脉瘤性SAH后常发生严重的水钠紊乱,加强监测并根据不同的发病原因进行早期有效的治疗对提高动脉瘤性SAH的治愈率、降低死亡率和致残率具有重要的临床意义。

Objective To discuss the clinical characteristics, diagnosis and treatment of water-sodium disturbance after aneurysmal subarachnoid hemorrhage （ SAH ）. Methods 56 cases with water - sodium disturbance after aneurysmal SAH were divided into hyponatremia, hypematremia and diabetes insipidus according to the clinical manifestation and laboratory examination. Clinical characteristics and diagnostic criteria were analyzed. The treatment was adjusted according to the laboratory examination and basic principle of water - sodium disturbance treatment. Results In the 56 cases with water - sodium disturbance after aneurysmal SAH, there were 49 cases of hyponatremia, 5 cases of hypematremia and 2 cases of diabetes insipidus. The curative effect was assessed by the GOS： 31 cases recovered well, 14 cases was moderate disability, 6 cases was severe disability, 2 cases was vegetative survival, and 3 cases died. Conclusion Aneurysmal subarachnoid hemorrhage often cause severe water- sodium disturbance. It is significant to raise the curative rate of aneurysmal SAH, decrease the mortality by the monitoring and early, effective treatment of different etiopathogenesis.