颅内动脉瘤破裂后并发低钠血症的类型与动脉瘤位置的关系  

Relationship between type of hyponatremia after intracranial aneurysm rupture and location of aneurysm

作　　者：杜赛 刘岳 傅楚华 胡少荣 关俊宏[2] DU Sai;LIU Yue;FU Chuhua(Department of Neurosurgery,Xiangyang NO.1 People's Hospital,Hubei University of Medicine,Xiangyang 441000,China)

机构地区：[1]湖北医药学院附属襄阳市第一人民医院神经外科,襄阳441000 [2]中国医科大学附属盛京医院神经外科 [3]襄阳市中心医院神经外科

出　　处：《临床神经外科杂志》2023年第6期646-652,共7页Journal of Clinical Neurosurgery

基　　金：湖北省教育厅科学研究计划资助项目(D202222103)。

摘　　要：目的探讨抗利尿激素分泌异常综合征(SIADH)和脑耗盐综合征(CSWS)在动脉瘤蛛网膜下腔出血(aSAH)并发低钠血症中的发生率是否因破裂动脉瘤的位置而不同。方法回顾性分析2016年1月—2018年12月中国医科大学附属盛京医院神经外科收治的aSAH并发低钠血症患者的临床资料,根据低钠血症病因,分为SIADH组(N=120)和CSWS组(N=40),观察比较两组的临床特征。采用单因素分析和多因素Logistic回归分析低钠血症病因的影响因素。结果共有160例患者纳入研究,其中SIADH患者120例(75)、CSWS患者40例(25%);前循环动脉瘤102例(64%),后循环动脉瘤58例(36%)。单因素分析证实,与后循环动脉瘤相比,SIADH在前循环动脉瘤中比CSW更常见(P=0.004);与其他部位相比,前交通动脉瘤患者中SIADH发生率较CSWS更高(P=0.038);更严重的Hunt-Hess分级与CSWS的发展有关(P=0.007);与SIADH组患者相比,CSWS组患者更多发生早期低钠血症(P=0.03)。多因素Logistic回归分析中进一步证实,前循环动脉瘤患者SIADH的发生率明显高于后循环动脉瘤患者(P=0.041)。CSWS在Hunt-Hess分级3~4级患者中发生率更高(P=0.013)。结论SIADH是aSAH患者低钠血症的主要原因,比CSWS更常见。前循环动脉瘤患者中SIADH的发生率高于后循环动脉瘤。Objective To explore whether the syndrome of inappropriate antidiuretic hormone secretion(SIADH)and cerebral salt wasting syndrome(CSWS)in aneurysmal subarachnoid hemorrhage(aSAH)complicated with hyponatremia varies depending on the location of ruptured aneurysms.Methods The clinical data of patients with aSAH complicated with hyponatremia admitted to the Department of Neurosurgery,Shengjing Hospital Affiliated to China Medical University from January 2016 to December 2018 were analyzed retrospectively.Based on the etiology of hyponatremia,they were divided into SIADH group(N=120)and CSWS group(N=40),and their clinical characteristics were observed and compared.Single factor analysis and multivariate logistic regression were used to analyze the influencing factors of hyponatremia.Result A total of 160 patients were included in the study,including 120 patients with SIADH(75%)and 40 patients with CSWS(25%);There were 102 cases(64%)of anterior circulation aneurysms and 58 cases(36%)of posterior circulation aneurysms.Univariate analysis confirmed that SIADH was more common in anterior circulation aneurysms than CSW compared to posterior circulation aneurysms(P=0.004).Compared with other sites,the incidence of SIADH in patients with anterior communicating artery aneurysm was higher than that in CSWS(P=0.038).More severe Hunt Hess grading was associated with the development of CSWS(P=0.007).Compared with patients in SIADH group,patients in CSWS group experienced more early hyponatremia(P=0.03).Multiple logistic regression analysis further confirmed that the incidence of SIADH in patients with anterior circulation aneurysms was significantly higher than that in patients with posterior circulation aneurysms(P=0.041).The incidence of CSWS was higher in Hunt Hess grade 3-4 patients(P=0.013).Conclusions SIADH is the leading cause of hyponatremia in aSAH patients and is more common than CSWS.The incidence of SIADH is higher in patients with anterior circulation aneurysms than in patients with posterior circulation aneurysms.

关 键 词：低钠血症 抗利尿激素分泌异常综合征 脑耗盐综合征 动脉瘤部位 

分 类 号：R743.3[医药卫生—神经病学与精神病学]