A Randomized controlled trial of hydrocortisone against hyponatremia in patients with aneurysmal subarachnoid hemorrhage
A Randomized controlled trial of hydrocortisone against hyponatremia in patients with aneurysmal subarachnoid hemorrhage
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DOI：
10.1161/strokeaha.106.480038
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发表时间：
2007-08-01
期刊：
影响因子：
8.3
通讯作者：
Yoshimine, Toshiki
中科院分区：
文献类型：
--
作者：
Katayama, Yoichi;Haraoka, Jo;Yoshimine, Toshiki
低钠血症是蛛网膜下腔出血后常见的并发症.它是由钠尿引起的，钠尿引起渗透性利尿并减少血容量，导致症状性脑血管痉挛（SCV）。在这种情况下，预防SCV的高血容量疗法将无效。我们进行了一项随机对照试验，以评估氢化可的松，促进钠潴留在kidney.Methods-七十一SAH患者手术后随机分配到治疗与安慰剂（n = 36）或1200 mg/d的氢化可的松（n = 35）为10天，此后逐渐减少的疗效。两组均接受高血容量治疗。主要终点是预防低钠血症。结果-氢化可的松防止过量钠排泄（P = 0.04）和尿量（P = 0.04）。氢化可的松在14天内维持了目标血钠水平（P <0.001），并实现了低钠和低液体补充的管理方案（P = 0.007）。氢化可的松能维持正常血浆渗透压（P <0.001）。安慰剂组9例患者（25%）和氢化可的松组5例患者（14%）发生SCV。两组之间的总体结果无显著差异。结论-氢化可的松克服了过度尿钠排泄，防止低钠血症。虽然结果没有差异，氢化可的松支持有效的高血容量治疗。
Background and Purpose - Hyponatremia is common after aneurysmal subarachnoid hemorrhage ( SAH). It is caused by natriuresis, which induces osmotic diuresis and decreases blood volume, contributing to symptomatic cerebral vasospasm ( SCV). Hypervolemic therapy to prevent SCV will not be efficient under this condition. We conducted a randomized controlled trial to assess the efficacy of hydrocortisone, which promotes sodium retention in the kidneys.Methods - Seventy-one SAH patients were randomly assigned after surgery to treatment with either a placebo ( n = 36) or 1200 mg/d of hydrocortisone ( n = 35) for 10 days and tapered thereafter. Both groups underwent hypervolemic therapy. The primary end point was the prevention of hyponatremia.Results - Hydrocortisone prevented excess sodium excretion ( P = 0.04) and urine volume ( P = 0.04). Hydrocortisone maintained the targeted serum sodium level throughout the 14 days ( P < 0.001), and achieved the management protocol with lower sodium and fluid ( P = 0.007) supplementation. Hydrocortisone kept the normal plasma osmolarity ( P < 0.001). SCV occurred in 9 patients ( 25%) in the placebo group and in 5 ( 14%) in the hydrocortisone group. No significant difference in the overall outcome was observed between the 2 groups.Conclusions - Hydrocortisone overcame excess natriuresis and prevented hyponatremia. Although there was no difference in outcome, hydrocortisone supported efficient hypervolemic therapy.