The Clinical Analysis Of Hyponatremia After Aneurysmal Subarachnoid Hemorrhage

Objective: To investigate the hyponatremia incidence and mechanism in patients with aneurysmal subarachnoid hemorrhage and the correlation with Hunt-Hess grading and symptomatic cerebrovascular spasms (SCVS) and prognosis.Methods: Totally 136 patients who had clipped cerebral aneurysm after aneurismal SAH at China-Japan Hospital at ChangChun were divided into different groups based on the location of the aneurysms, concentration of natrium, Hunt-Hess grading and extent of third ventricle. We analyzed retrospectively the collected data.Results: The total incidence of hyponatremia following aneurysmal SAH was 64.7%, the incidences of severe hyponatremia were 6.6%; The incidences of hyponatremia of four groups which based on location of the aneurysms were 69.8%, 55.2%, 70.1%and 56.5% and the incidences of severe hyponatremia were 11.3%, 6.9%, 0% and 4.3% respectively. The incidences of hyponatremia in Hunt-Hess grade III-IV and I-II were 65.4% and 62.5% and the incidences of severe hyponatremia were 4.8% and 1.25%. The incidences of SCVS with and without hyponatremia were 10.4% and 17.0%. The incidences of SCVS in Hunt-Hess grade III-IV and I-II were 14.4% and 15.6%. The incidences of depravation in mild hyponatremia, severe hyponatremia, normal groups were 10.2%, 22.2% and 20.8% respectively. The incidences of hyponatremia in extent of the third ventricle≥1.0cm and <1.0cm groups were 100% and 61.9%; The incidence of depravation in the early 3 days was 3.0%, and in the 6th -9th days was 73.9%; After a week treatment, The incidence of depravation in the concentration of natrium became normal, still mild hyponatremia and severe hyponatremia were 6.25%, 3.33% and 100%.Conclusion: 1. Hyponatremia following aneurysmal subarachnoid hemorrhage is easy to happen. The incidence of hyponatremia is about 67.4%. 2. The correlation of the location of the aneurysm and hyponatremia wasn't statistically different. 3. The incidence of hyponatremia and severe hyponatremia in Hunt-Hess grade III-IV and Hunt-Hess grade I-II wasn't statistically different. 4. The incidence of SCVS in the hyponatremia group and normal group wasn't statistically different. The incidence of SCVS in Hunt-Hess grade III-IV and Hunt-Hess grade I-II wasn't statistically different. 5. The incidence of depravation in the severe hyponatremia, mild hyponatremia group and normal group wasn't statistically different. 6. The extent of the third ventricle≥1.0cm had higher incidence of hyponatremia than <1.0cm. 7. The appearance of hyponatremia in the 6th-9th days had higher incidence of depravation than in the early 3 days. Still hyponatremia even the concentration of natrium duratively descending indicated depravation. 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.