TARGET SERUM SODIUM LEVELS DURING INTENSIVE CARE UNIT MANAGEMENT OF ANEURYSMAL SUBARACHNOID HEMORRHAGE
TARGET SERUM SODIUM LEVELS DURING INTENSIVE CARE UNIT MANAGEMENT OF ANEURYSMAL SUBARACHNOID HEMORRHAGE
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DOI：
10.1097/shk.0000000000000897
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发表时间：
2017-11-01
期刊：
影响因子：
3.1
通讯作者：
Kuroda, Yasuhiro
中科院分区：
文献类型：
--
作者：
Okazaki, Tomoya;Hifumi, Toru;Kuroda, Yasuhiro
简介：钠血症常见于重症监护病房 (ICU) 治疗动脉瘤性蛛网膜下腔出血 (SAH) 患者。然而，即使目前的指导方针也没有提供详细的管理策略。本研究的目的是检查血清钠水平异常与不良神经系统结局的关系，并确定 SAH 患者血清钠的目标范围。方法：我们回顾性分析了 2009 年 1 月至 2015 年 12 月期间连续住院并确诊为 SAH 的所有患者。进行单变量/多变量分析以确定不良神经系统结局（出院时改良 Rankin 量表 3-6 级）的独立预测因素。结果：本研究共纳入 131 名患者。 45% 的患者出现不良的神经系统结果。在多元回归分析中，年龄、Hunt 和 Kosnik 分级以及 ICU 中的血清钠水平处于最高水平[比值比 (OR)，1.18； 95% CI，1.05-1.35； P < 0.01] 和最小值（OR，0.88；95% CI，0.77-0.99；P = 0.048）值与不良神经系统结果显着相关。受试者工作特征曲线分析显示，截止血清钠水平最大值为145 mmol/L，最小值为132 mmol/L。入住 ICU 前 2 周出现低钠血症和高钠血症的患者占神经系统预后不良患者的 88.2%；而钠含量正常的人仅占15.6%。结论：在 SAH 患者中，ICU 管理期间的低钠血症和高钠血症均与不良神经系统结局显着相关。
Introduction: Dysnatremia commonly occur in the intensive care unit (ICU) management of patients with aneurysmal subarachnoid hemorrhage (SAH). However, detailed management strategies have not been provided even by current guidelines. The purposes of this study were to examine the association of abnormal serum sodium levels with unfavorable neurologic outcomes and to identify the target range of serum sodium in patients with SAH. Methods: We retrospectively reviewed all patients who were consecutively hospitalized with a confirmed diagnosis of SAH between January 2009 and December 2015. Univariate/multivariate analyses were performed to identify the independent predictors of an unfavorable neurologic outcome (modified Rankin scale of 3-6 upon hospital discharge). Results: There were 131 patients included in this study. Unfavorable neurologic outcomes occurred in 45% of patients. On multiple regression analysis, age, Hunt and Kosnik grade, and serum sodium levels in the ICU at the maximum [odds ratio (OR), 1.18; 95% CI, 1.05-1.35; P < 0.01] and minimum (OR, 0.88; 95% CI, 0.77-0.99; P = 0.048) values were significantly associated with unfavorable neurologic outcomes. The receiver operating characteristic curve analysis showed that the cut-off serum sodium levels were 145 mmol/L for maximum value and 132 mmol/L for minimum value. Patients with hyponatremia and hypernatremia during the first 2 weeks in the ICU accounted for 88.2% of patients with an unfavorable neurologic outcome; whereas, those with normal sodium levels accounted for only 15.6%. Conclusions: In patients with SAH, both hyponatremia and hypernatremia during ICU management were significantly associated with unfavorable neurologic outcomes.