The Clinical Research Of Hyponatremia Following Aneurysmal Subarachnoid Hemorrhage

Objective:To investigate the pathogenesis of hyponatremia following aneurysmal subarachnoid hemorrhage(SAH) and analyse the incidence of hyponatremia and their correlation with Fisher grade, symptomatic cerebrovascular spasms(SCVS) and prognosis.Methods:Select 126 patients who came to the second hospital of ShanDong University from March 2002 to February 2005 .Male:56 cases, Female:70 cases.The range of the patients' onset age:21 years old to 70 years old. Through the cerebral CT and DSA examination, the 126 patients were devided into anterior circulation aneurysm group(54cases, Fisher grade Ⅰ-Ⅱ:34 cases, Fisher grade Ⅲ—Ⅳ :20 cases), posterior circulation aneurysm group (43cases, Fisher grade Ⅰ-Ⅱ:25 cases, Fisher grade Ⅲ — Ⅳ : 18 cases)and middle carotid artery aneurysm group(29 cases, Fisher grade Ⅰ -Ⅱ:16 cases, Fisher grade Ⅲ—Ⅳ:13 cases) according to the locations of aneurysm.And the patients were devided into hyponatremia group and normal group according to the serum natrium level.The incidences and clinical characters of hyponatremia were analyzed respectively.Results: The total incidence of hyponatremia following aneurysmal SAH was 29.4%. The incidences of hyponatremia of three groups were 46. 3%, 16. 3% and 17.2% and the incidences of severe hyponatremia were 29.6%, 7.0% and 6.9% respectively. The incidences of hyponatremia in Fisher grade Ⅲ~Ⅳ and Ⅰ ~ Ⅱ were 47.1% and 17. 3% and the incidences of severe hyponatremia were 31. 4% and 6. 7%. The incidences of SCVS with and without hyponatremia were 51. 4% and 20. 2%. The incidences of SCVS in Fisher grade Ⅲ—Ⅳ and Ⅰ —Ⅱ were 51.0%and 14. 7%. The incidences of depravation with and without hyponatremia were 43.2% and 20.2%.The incidence of depravation with slight hyponatremia was 25. 0% and the incidence of death or depravation with severe hyponatremia was 57. 1%. Conclusion:1. Hyponatremia following aneurysmal subarachnoid hemorrhage is easy to happen. The incidence of hyponatremia is about 30%.2. The anterior circulation aneurysm group had a significantly higher incidence of hyponatremia and severe hyponatremia than other groups.3.The incidence of hyponatremia and severe hyponatremia in SAH Fisher grade III~IV was higher than Fisher grade I — II. The incidence of hyponatremia correlated positively with the severity of SAH.4.The hyponatremia group had a higher incidence of SCVS than normal group. Hyponatremia correlated closely with SCVS.5. The incidence of SCVS in Fisher grade III—IV was higher than Fisher gradeI ~II. The incidence of SCVS correlated positively with the severity of SAH.6. The hyponatremia group had a higher incidence of death or depravation than normal group. Hyponatremia correlated closely with the prognosis.Patients with aneurysmal SAH should be carefully observed and treated as soon as possible. It should be vitals to improve the knowledge about the pathogenesis of hyponatremia following aneurysmal SAH.