血钠、血钾水平对颅内破裂动脉瘤夹闭术后继发分流依赖性脑积水的预测价值

Value of serum levels of sodium and potassium in prediction of shunt-dependent hydrocephalus in patients with ruptured intracranial aneurysms after clipping

目的 探讨血钠、血钾水平对颅内破裂动脉瘤夹闭术后继发分流依赖性脑积水(SDH)的预测价值。方法 回顾性分析2017年1月至2022年10月接受开颅夹闭术治疗的239例颅内破裂动脉瘤的临床资料。术后2~4周CT检查表现为脑室进行性增大以及需永久依赖分流术才能改善症状的病人诊断为SDH。结果 239例中,61例术后发生SDH,发生率为25.5%。分流术距发病的中位时间为51 d(32~72 d)。入院时血钠水平为(139.82±5.27)mmol/L,术后血钠水平逐渐升高,术后2 d达峰值[(148.82±5.10)mmol/L];入院时血钾水平为(3.52±0.52)mmol/L,术后2 d最低[(3.25±0.48)mmol/L]。与无SDH病人相比,SDH病人术后2~7 d血钠水平明显增高(P<0.05),入院时及术后2~7 d血钾水平明显降低(P<0.05)。多因素logistic回归分析显示,入院时和术后2 d血钾降低、术后2 d血钠增高是SDH的独立危险因素(P<0.05)。ROC曲线分析显示,入院时血钾≤3.25 mmol/L、术后2 d血钾≤3.00 mmol/L/术后2 d血钠≥146.65 mmol/L预测a SAH后SDH的曲线下面积分别为0.835(95%CI 0.775~0.895)、0.767(95%CI 0.691~0.843)、0.773(95%CI 0.701~0.844)。结论 颅内破裂动脉瘤夹闭术后发生SDH的几率较高,入院时和术后2 d血钾水平降低、术后2 d血钠水平增高对SDH有一定的预测价值。

Objective To investigate the value of serum levels of sodium and potassium in predicting shunt-dependent hydrocephalus(SDH)in patients with ruptured intracranial aneurysms after clipping.Methods The clinical data of 239 patients with ruptured intracranial aneurysms who received clipping from January 2017 to October 2022 were retrospectively analyzed.The patients who were presented with progressive ventricular enlargement on CT 2~4 weeks after the surgery and need permanent shunt to improve symptoms were diagnosed as SDH.Results Of these 239 patients,61 patients(25.5%)developed SDH after clipping.The median time interval between onset and shunt was 51 days(32~72 days).The serum sodium level was(139.82±5.27)mmol/L on admission,and it gradually increased after the surgery,reaching a peak of(148.82±5.10 mmol/L)2 days after the surgery.The serum potassium level was(3.52±0.52)mmol/L on admission,and the lowest was(3.25±0.48 mmol/L)2 days after the surgery.Compared with the patients without SDH,the serum sodium level in the patients with SDH was significantly increased 2~7 days after the surgery(P<0.05),and the serum potassium level on admission and 2~7 days after the surgery was significantly decreased(P<0.05).Multivariate logistic regression analysis showed that the decrease of serum levels of potassium on admission and 2 days after the surgery,and the increase of serum level of sodium 2 days after the surgery were independent risk factors for SDH(P<0.05).ROC curve analysis showed that the areas under the curve of serum level of potassium on admission≤3.25 mmol/L,serum level of potassium 2 days after the surgery≤3.00 mmol/L and serum level of sodium 2 days after the surgery≥146.65 mmol/L for predicting SDH were 0.835(95%CI 0.775~0.895),0.767(95%CI 0.691~0.843)and 0.773(95%CI 0.701~0.844),respectively.Conclusions The incidence of SDH is high in patients with ruptured intracranial aneurysms after clipping.The decrease of serum levels of potassium on admission and 2 days after clipping,and the increase of serum levels of sodium 2 days after clipping have certain predictive value for SDH.