Sherlock Mark, O'Sullivan Eoin, Agha Amar, Behan Lucy Ann, Rawluk Danny, Brennan Paul, Tormey William, Thompson Christopher J
Department of Academic Endocrinology, National Neurosurgical Centre, Beaumont Hospital, Dublin 9, Ireland.
Clin Endocrinol (Oxf). 2006 Mar;64(3):250-4. doi: 10.1111/j.1365-2265.2006.02432.x.
Hyponatraemia is common following subarachnoid haemorrhage (SAH) but the pathogenesis is unclear. Objective To establish the incidence, pathophysiology and consequences of hyponatraemia following SAH.
A retrospective case-note analysis of all patients with SAH admitted to Beaumont Hospital between January 2002 and September 2003. Three hundred and sixteen cases of SAH were substantiated by computed tomography (CT) scan and angiogram findings. Hyponatraemia was defined as plasma sodium < 135 mmol/l.
One hundred and seventy-nine patients (56.6%) developed hyponatraemia and 62 (19.6%) developed significant hyponatraemia (plasma sodium < 130 mmol/l). The incidence of severe hyponatraemia following hypophysectomy was lower in the period of analysis (5/81, 6.2%, P < 0.01). Hyponatraemia was more common in patients with identified aneurysms (anterior circulation 102/168, 60.7%, posterior circulation 56/95, 60.8%) than in those with no radiological aneurysm (21/54, 38.8%, P < 0.001). Hyponatraemia was more common after aneurysmal clipping (68/103, 66%) or coiling (82/132, 62%) than after conservative treatment (29/81, 36%, P < 0.001). The aetiology of significant hyponatraemia was the syndrome of inappropriate antidiuretic hormone secretion (SIADH) 39/62 (69.2%), cerebral salt-wasting syndrome (CSWS) 4/62 (6.5%), hypovolaemic hyponatraemia 13/62 (21%), hypervolaemic hyponatraemia 3/62 (4.8%) and mixed CSW/SIADH 3/62 (4.8%). Hyponatraemia was associated with longer hospital stay (24.0 +/- 2.6 vs. 11.8 +/- 0.8 days, P < 0.001) but did not affect mortality (P = 0.07). Hyponatraemia developed more than 7 days following SAH in 21.4% and more then 7 days following intervention in 31.8%.
Hyponatraemia is common following SAH and is associated with longer hospital stay. Clipping and coiling of aneurysms are associated with higher rates of hyponatraemia. SIADH is the commonest cause of hyponatraemia after SAH. Delayed hyponatraemia is common, and has implications for early discharge strategies.
蛛网膜下腔出血（SAH）后低钠血症很常见，但发病机制尚不清楚。目的：确定SAH后低钠血症的发生率、病理生理学及后果。
对2002年1月至2003年9月入住博蒙特医院的所有SAH患者进行回顾性病例分析。通过计算机断层扫描（CT）和血管造影结果证实了316例SAH病例。低钠血症定义为血浆钠<135 mmol/L。
179例患者（56.6%）发生低钠血症，62例（19.6%）发生严重低钠血症（血浆钠<130 mmol/L）。分析期间垂体切除术后严重低钠血症的发生率较低（5/81，6.2%，P<0.01）。已确定动脉瘤的患者中低钠血症更常见（前循环102/168，60.7%，后循环56/95，60.8%），而无放射学动脉瘤的患者中低钠血症较少见（21/54，38.8%，P<0.001）。动脉瘤夹闭（68/103，66%）或栓塞（82/132，62%）后低钠血症比保守治疗后更常见（29/81，36%，P<0.001）。严重低钠血症的病因是抗利尿激素分泌不当综合征（SIADH）39/62（69.2%）、脑性盐耗综合征（CSWS）4/62（6.5%）、低血容量性低钠血症13/62（21%）、高血容量性低钠血症3/62（4.8%）以及混合性CSW/SIADH 3/62（4.8%）。低钠血症与住院时间延长有关（24.0±2.6天对11.8±0.8天，P<0.001），但不影响死亡率（P=0.07）。SAH后7天以上发生低钠血症的占21.4%，干预后7天以上发生低钠血症的占31.8%。
SAH后低钠血症很常见，且与住院时间延长有关。动脉瘤夹闭和栓塞与低钠血症发生率较高有关。SIADH是SAH后低钠血症最常见的原因。迟发性低钠血症很常见，对早期出院策略有影响。
