低钠血症及血钠波动对动脉瘤性蛛网膜下腔出血患者预后影响研究.docVIP

低钠血症及血钠波动对动脉瘤性蛛网膜下腔出血患者预后的影响研究 　　摘 要：目的 ?^察动脉瘤性蛛网膜下腔出血（aSAH）中低钠血症与血钠波动的特点，分析低钠血症与钠波动的关系及对预后的影响。方法 回顾性分析重庆医科大学附属第一医院2017年1月～8月收治的189例aSAH病例，根据血钠波动最大值，分为12 mmol/L三组，以Rankin修订量表评分（mRS）评估患者预后，使用Logistic回归分析血钠波动与患者预后的联系。结果 mRS≥4组的患者发病后入院时间间隔短于mRS≤1组，mRS≥4组的患者鞍上池出血区域CT值均值最高，差异有统计学意义（P0.05）。每日钠波动6～12 mmol/L组中，mRS≤1者26例（31.71%），2≤mRS≤3者25例（30.49%），mRS≥4者31例（37.80%）；12mmol/L组中mRS≤1者1例（6.67%），2≤mRS≤3者2例（13.33%），mRS≥4者12例（80.00%）。病程中血钠波动6～12 mmol/L及12 mmol/L组，较6 mmol/L组患者mRS评分更高，预后更差，差异具有统计学意义（P0.05）。结论 aSAH患者中，血钠的波动，而非低血钠本身，与不良神经功能预后有统计学关联，这与现行的理念存在冲突，有待更进一步的临床探索。 　　关键词：动脉瘤性蛛网膜下腔出血；血钠波动；低钠血症；Rankin修订量表评分 　　中图分类号：R743.35 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.03.023 　　文章编号：1006-1959（2018）03-0073-05 　　Abstract：Objective To observe the characteristics of hyponatremia and blood sodium fluctuation in patients with aneurysm subarachnoid hemorrhage（aSAH），and to analyze the relationship between hyponatremia and sodium fluctuation and its influence on prognosis.Methods A total of 189 cases of aSAH admitted from January to August 2017 in the first affiliated Hospital of Chongqing Medical University were retrospectively analyzed.According to the maximum fluctuation of blood sodium，they were divided into three groups，12 mmol/L.The prognosis of the patients was evaluated by the revised Rankin scale score （mRSs），logistic regression analysis was used to analyze the relationship between serum sodium fluctuation and prognosis.Results The interval of admission in mRS≥4 group was shorter than that in mRS≤1 group.The mRS 4 group had the highest mean CT value in the hemorrhage area of suprasellar cistern，and the difference was statistically significant（P0.05）.The daily sodium fluctuation in 6～12 mmol/L group，mRS≤1 in 26 cases（31.71%），2≤mRS≤3 in 25 cases（30.49%），mRS≥4 in 31 cases（37.80%）；12mmol/L group，mRS≤1 in 1 case（6.67%），2≤mRS≤3 in 2 cases （13.33%）and mRS≥4 in 12 cases（80.00%）.Serum sodium fluctuated between 6 and 12 mmol/L and12 mmol/L during the course of the disease，with a higher m