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首页> 外文期刊>Neurosurgery >Prognostic significance of hypernatremia and hyponatremia among patients with aneurysmal subarachnoid hemorrhage.
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Prognostic significance of hypernatremia and hyponatremia among patients with aneurysmal subarachnoid hemorrhage.

机译：高钠血症和低钠血症在动脉瘤性蛛网膜下腔出血患者中的预后意义。

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OBJECTIVE: Abnormal serum sodium levels (hyponatremia and hypernatremia) are frequently observed during the acute period after aneurysmal subarachnoid hemorrhage (SAH) and may worsen cerebral edema and mass effect. We performed this study to determine the prognostic significance of serum sodium concentration abnormalities. METHODS: We analyzed prospectively collected data for the placebo treatment group in a clinical trial conducted at 54 neurosurgical centers in North America. The presence of hypernatremia (serum sodium concentration of >145 mmol/L) and hyponatremia (serum sodium concentration of <135 mmol/L) was determined with serum sodium measurements obtained at admission and 3, 6, and 9 days after SAH. The effects of hypernatremia and hyponatremia on the risk of symptomatic vasospasm and on 3-month outcomes were analyzed after adjustment for the following potential confounding factors: age, sex, preexisting hypertension, admission Glasgow Coma Scale score, initial mean arterial pressure, subarachnoid clot thickness, intraventricular blood or intraparenchymal hematoma, ventricular dilation, and aneurysm size and location. RESULTS: Of 298 patients in the analysis, 58 (19%) developed hypernatremia and 88 (30%) developed hyponatremia. Hypernatremia was significantly associated with poor outcomes (odds ratio, 2.7; 95% confidence interval, 1.2-6.1). A positive correlation was observed between the highest sodium values recorded and Glasgow Outcome Scale scores at 3 months (P < 0.0001 by analysis of variance). Hyponatremia was not associated with 3-month outcomes (odds ratio, 1.9; 95% confidence interval, 0.9-4.3). Neither hypernatremia nor hyponatremia was associated with the risk of symptomatic vasospasm. CONCLUSION: Hyponatremia seems to be more common than hypernatremia after SAH. However, hypernatremia after SAH is independently associated with poor outcomes, and this association is independent of previously identified outcome predictors, including age and admission Glasgow Coma Scale scores. Further studies are needed to define the underlying mechanism of this association.
机译：目的：在动脉瘤性蛛网膜下腔出血（SAH）后的急性期，经常观察到异常的血清钠水平（低钠血症和高钠血症），并可能加重脑水肿和质量效应。我们进行了这项研究，以确定血清钠浓度异常的预后意义。方法：我们在北美54个神经外科中心进行的一项临床试验中分析了安慰剂治疗组的前瞻性收集数据。通过在入院时以及SAH后3、6和9天获得的血清钠含量测定高钠血症（血清钠浓度> 145 mmol / L）和低钠血症（血清钠浓度<135 mmol / L）的存在。调整以下潜在混杂因素后，分析了高钠血症和低钠血症对症状性血管痉挛风险和3个月结局的影响：年龄，性别，既往高血压，入院格拉斯哥昏迷量表评分，初始平均动脉压，蛛网膜下血凝块厚度，脑室内血液或实质内血肿，心室扩张以及动脉瘤的大小和位置。结果：在分析的298例患者中，58例（19％）发生了高钠血症，88例（30％）发生了低钠血症。高钠血症与不良预后显着相关（比值比为2.7; 95％置信区间为1.2-6.1）。观察到的最高钠值与3个月时的格拉斯哥成果量表得分之间存在正相关（通过方差分析，P <0.0001）。低钠血症与3个月预后无关（优势比为1.9; 95％置信区间为0.9-4.3）。高钠血症和低钠血症均与症状性血管痉挛的风险无关。结论：SAH后低钠血症似乎比高钠血症更为常见。但是，SAH后的高钠血症与不良预后独立相关，并且这种相关独立于先前确定的预后预测因素，包括年龄和格拉斯哥昏迷量表评分。需要进一步研究来确定这种关联的潜在机制。

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