血清钠水平与自发性脑出血患者脑水肿及预后的关系  

Relationship of serum sodium level with cerebral edema and prognosis in patients with spontaneous intracerebral hemorrhage

作　　者：王志敏[1] 王鹏[1] 金云龙[1] 辛花平[1] 肖雨[1] 郑娴[1] 胡美铃[1] 黄阳萍 叶佳媚[1] 彭霜霜 陶晓晓[1] 

机构地区：[1]浙江省台州市第一人民医院神经内科脑血管病中心

出　　处：《中华老年医学杂志》2015年第7期745-747,共3页Chinese Journal of Geriatrics

基　　金：浙江省科技厅立项（2014C33258）;台州市科技局项目（08IKY31）

摘　　要：目的探讨血清钠水平的控制情况与自发性脑出血后脑水肿的变化及预后关系。方法通过前瞻性研究方法观察90例24h内的白发性脑出血患者。根据预设血清钠水平的目标值随机分为相对低钠组30例（135～140mmol／L），相对高钠组30例（140～145mmol／L），绝对高钠组30例（145～155mol／L）。起病24h内给予评定美国国立卫生研究院卒中量表（NIHSS）、格拉斯哥昏迷评分（GCS）及测定血钠等血液学数据，并动态监测24h内、第3、7天的脑出血量、脑水肿量、肝肾功能变化。90d时评定改良Rankin量表（MRS评分）以评估患者神经功能恢复情况。改良Rankin量表≤2分为预后良好。结果绝对高钠组第7天水肿的体积（25．37±26．54）ml小于相对低钠组（55．21±58．21）ml及相对高钠组（59．48±55．84）ml（F=1．492，P=0．023）。绝对高钠组3个月时MRS评分≤2分的百分数为70．0％，较相对低钠组与相对高钠组预后好（P〈0．05）。而三组颅内血肿体积差异无统计学意义（P〉O．05）。结论适当的升高血清钠是安全的，它能减轻脑水肿，获得相对较好的预后。Objective To investigate the association of serum sodium level with cerebral edema and prognosis in patients with spontaneous intracerebral hemorrhage. Methods We prospectively studied 90 patients with spontaneous intracerebral hemorrhage within 24 hours from onset of symptoms. According to the target value of serum sodium level, the patients were divided into 3 groups, relatively low-sodium group （135-140 retool/L）, relatively high-sodium group （140-145 mmol/L）, absolute high sodium group （ 145-155mmol/L）（n=30 for each）. National institutes of health stroke scale （NIHSS）, Glasgow coma score （GCS）, and blood tests were measured within 24 hours from onset. Hematoma volumes, edema volumes, liver and kidney function were measured within 24 hours, 3 days, 7 days after onset. Modified rankin scale （MRS） were measured at 90 days to assess the recovery of neurological function. Modified rankin scale score ≤ 2 was considered as good outcome. Results The edema volume was smaller in absolute high-sodium group than in relatively low-sodium group and relatively high-sodium group [（25.37± 26.54） ml vs. （55.21 ± 58.21） ml, （59.48±-55.84） ml, F=1. 492, P=0. 0233. The percentage of patients with MRS score ≤ 2 was 70%o in absolute high-sodium group, which had a better prognosis as compared with relatively low-sodium and relatively high sodium group （both P〈 0.05） . The hematoma volume had no significant difference among the three groups. Conclusions The appropriate increase in serum sodium level is safe, which could reduce cerebral edema and get a better prognosis.

关 键 词：脑出血 脑水肿 钠 

分 类 号：R743.34[医药卫生—神经病学与精神病学]