Influence of raised plasma osmolality on clinical outcome after acute stroke
Influence of raised plasma osmolality on clinical outcome after acute stroke
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DOI：
10.1161/01.str.31.9.2043
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发表时间：
2000-09-01
期刊：
影响因子：
8.3
通讯作者：
Rudd, AG
中科院分区：
文献类型：
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作者：
Bhalla, A;Sankaralingam, S;Rudd, AG
背景和目的：急性卒中后生理参数异常可能导致早期神经功能恶化。关于脱水对卒中结局影响的研究有限。我们研究了在3个月的中风结果和血浆渗透压与水化后的第一个星期stroke. Methods急性中风患者的血浆渗透压测定在入院时，并在第1，3和7天的血浆渗透压的变化，血浆渗透压升高的关联。还计算了第一周期间的最大血浆渗透压摩尔浓度和曲线下面积（AUC）。根据患者的水合方式对患者进行分层：口服、静脉注射或两者兼而有之。结果包括卒中后3个月的生存率。进行逻辑回归以检查升高的血浆渗透压（>296 mOsm/kg）与存活率之间的关系，校正卒中严重程度。进行线性回归，以检查模式的血浆渗透压跨水化groups. Results-167例患者。入院时的平均（300 mOsm/kg，SD 11.4），最大值（308.1 mOsm/kg，SD 17.1）和AUC（298.3 mOsm/kg，SD 11.7）死亡组的血浆渗透压显著高于存活组（分别为293.1 mOsm/kg [SD 8.2]、297.7 mOsm/kg [SD 8.7]和291.7 mOsm/kg [SD 8.1]; P296 mOsm/kg与死亡率显著相关（OR 2.4，95% CI 1.0 - 5.9）。在静脉补液的患者中，与口服补液的患者相比，血浆渗透压摩尔浓度没有显著下降（P=0.68）。结论：经病例组合校正后，入院时血浆渗透压摩尔浓度升高与卒中死亡率相关。中风后脱水的纠正需要更系统的方法。需要进行试验以确定纠正中风后脱水是否能改善预后。
Background and Purpose-Abnormal physiological parameters after acute stroke may induce early neurological deterioration. Studies of the effect of dehydration on stroke outcome are limited. We examined the association of raised plasma osmolality on stroke outcome at 3 months and the change of plasma osmolality with hydration during the first week after stroke.Methods-Acute stroke patients had their plasma osmolality measured at admission and at days 1, 3, and 7. Maximum plasma osmolality and the area under curve (AUC) were also calculated during the first week. Patients were stratified according to how they were hydrated: orally, intravenously, or both. Outcome included survival at 3 months after stroke. Logistic regression was performed to examine the association between raised plasma osmolality (>296 mOsm/kg) and survival, adjusting for stroke severity. Linear regression was performed to examine the pattern of plasma osmolality across hydration groups.Results-One hundred sixty-seven patients were included. Mean admission (300 mOsm/kg, SD 11.4), maximum (308.1 mOsm/kg, SD 17.1), and AUC (298.3 mOsm/kg, SD 11.7) plasma osmolality were significantly higher in those who died compared with survivors (293.1 mOsm/kg [SD 8.2], 297.7 mOsm/kg [SD 8.7], and 291.7 mOsm/kg [SD 8.1], respectively; P296 mOsm/kg was significantly associated with mortality (OR 2.4, 95% CI 1.0 to 5.9). In patients hydrated intravenously, there was no significant fall in plasma osmolality compared with patients hydrated orally (P=0.68).Conclusions-Raised plasma osmolality on admission is associated with stroke mortality, after correcting for case mix. Correction of dehydration after stroke requires a more systematic approach. Trials are required to determine whether correcting dehydration after stroke improves outcome.