颅内破裂动脉瘤开颅夹闭术后继发低钠血症的影响因素及治疗分析

Risk factors and treatment of secondary hyponatremia in patients with ruptured intracranial aneurysms after surgical clipping

目的探讨颅内破裂动脉瘤开颅夹闭术后继发低钠血症的危险因素及治疗方法。方法回顾性分析2018年1月至2022年1月开颅夹闭术治疗的102例颅内破裂动脉瘤的临床资料。术后1周内血钠连续两次低于135 mmol/L诊断为低钠血症,多因素logistic回归模型分析低钠血症的危险因素;根据病人低钠血症原因[抗利尿激素分泌不当综合征(SIADH)和脑盐耗综合征(CSWS)]给予针对性治疗。结果102例中,40例术后出现低钠血症,发生率为39.2%;其中轻度19例,中度15例,重度6例;SI⁃ADH有23例,CSWS有17例。多因素logistic回归分析显示动脉瘤位于大脑前动脉及前交通动脉(OR=2.564;95%CI 1.035~6.349;P=0.042)、术前Hunt-Hess分级Ⅲ~Ⅳ级(OR=3.223;95%CI 1.306~7.953;P=0.011)、合并脑积水(OR=3.135;95%CI 1.097~8.963;P=0.033)是继发低钠血症的独立危险因素。出院前恢复正常血钠水平;术后随访3~6个月,6例因低钠血症出现头痛、恶心等,予口服或静脉补钠治疗,恢复正常。结论颅内破裂动脉瘤开颅夹闭术后易发生低钠血症,尤其是动脉瘤位于前交通动脉或大脑前动脉、高Hunt-Hess分级、合并脑积水的病人,更加要注意观察监测电解质水平,及时纠正,以改善病人的预后。

Objective To investigate the risk factors and treatment of secondary hyponatremia after surgical clipping of ruptured intracranial aneurysms.Methods The clinical data of 102 patients with ruptured intracranial aneurysms treated with surgical clipping from January 2018 to January 2022 were retrospectively analyzed.Hyponatremia was diagnosed when serum sodium fell below 135 mmol/L twice within 1 week after surgery.The risk factors of hyponatremia were analyzed by multivariate logistic regression model.Targeted treatment was performed according to the cause of hyponatremia[syndrome of inappropriate secretion of antidiuritic homone(SIADH)and cerebral salt wasting(CSWS)].Results Of these 102 patients,40 patients(39.2%)had hyponatremia after operation,including 19 mild,15 moderate,and 6 severe hyponatremia;23 SIADH and 17 CSWS.Multivariate logistic regression analysis showed that the location of aneurysms in the anterior cerebral artery and anterior communicating artery(OR=2.564;95%CI 1.035-6.349;P=0.042),preoperative Hunt-Hess gradeⅢ~Ⅳ(OR=3.223;95%CI 1.306-7.953;P=0.011),and combined hydrocephalus(OR=3.135;95%CI 1.097-8.963;P=0.033)were independent risk factors for secondary hyponatremia.The blood sodium level returned to normal in all patients before discharge.During the follow-up(3-6 months),6 patients had headache and nausea due to hyponatremia,and they recovered after oral or intravenous sodium supplementation.Conclusions Hyponatremia is easily occurred after surgical clipping of intracranial ruptured aneurysms,especially in patients with aneurysms located in the anterior communicating artery or anterior cerebral artery,high Hunt-Hess grade,and combined with hydrocephalus.More attention should be paid to the observation and monitoring of electrolyte levels,and timely correction,so as to improve the prognosis of patients.