Wijdicks E F, Vermeulen M, ten Haaf J A, Hijdra A, Bakker W H, van Gijn J
Ann Neurol. 1985 Aug;18(2):211-6. doi: 10.1002/ana.410180208.
We studied the sodium balance and changes in plasma volume by an isotope dilution technique in the first week after an aneurysmal subarachnoid hemorrhage in 21 patients. In 11 of the patients, the plasma volume decreased by more than 10%. This was accompanied by a negative sodium balance and hyponatremia in 6 patients, a negative sodium balance without hyponatremia in 4 patients, and a positive sodium balance in 1 patient. Together with a decrease in plasma volume, blood urea nitrogen content increased and body weight decreased. Three patients developed hyponatremia without a decrease in plasma volume. Serum vasopressin was measured in 14 of the 21 patients. The values were elevated on admission and declined in the first week, regardless of the presence of hyponatremia. These findings indicate that natriuresis and hyponatremia in aneurysmal subarachnoid hemorrhage reflect salt wasting and not inappropriate secretion of antidiuretic hormone and that these changes should be corrected by fluid replacement rather than by fluid restriction.
我们采用同位素稀释技术对21例动脉瘤性蛛网膜下腔出血患者在发病后第一周的钠平衡及血浆容量变化进行了研究。11例患者的血浆容量减少超过10%。其中6例伴有负钠平衡及低钠血症，4例有负钠平衡但无低钠血症，1例为正钠平衡。随着血浆容量的减少，血尿素氮含量升高，体重下降。3例患者出现低钠血症但血浆容量未减少。对21例患者中的14例测定了血清血管加压素。入院时其值升高，在第一周下降，无论是否存在低钠血症。这些发现表明，动脉瘤性蛛网膜下腔出血时的利钠和低钠血症反映的是盐耗竭，而非抗利尿激素分泌不当，并且这些变化应通过补液而非限制液体摄入来纠正。
