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Brain and Nerve No to Shinkei Volume 44, Issue 7 （July 1992）

Brain and Nerve 脳と神経 44巻7号（1992年7月発行）

Japanese English

原著

くも膜下出血後の低Na血症と脳血管攣縮 Hyponatremia and Cerebral Vasospasm in Patients with Aneurysmal Subarachnoid Hemorrhage 森永一生 ¹ , 林征志 ¹ , 松本行弘 ¹ , 大宮信行 ¹ , 三上淳一 ¹ , 上田幹也 ¹ , 佐藤宏之 ¹ , 井上慶俊 ¹ , 大川原修二 ¹ Kazuo Morinaga ¹ , Seiji Hayashi ¹ , Yukihiro Matsumoto ¹ , Nobuyuki Omiya ¹ , Junichi Mikami ¹ , Mikiya Ueda ¹ , Hiroyuki Sato ¹ , Yoshitoshi Inoue ¹ , Shuji Okawara ¹ ¹大川原脳神経外科病院 ¹Okawara Neurosurgical Hospital キーワード： subarachnoid hemorrhage , hyponatremia , cerebral vasospasm , dehydration Keyword: subarachnoid hemorrhage , hyponatremia , cerebral vasospasm , dehydration pp.629-632

発行日 1992年7月1日 Published Date 1992/7/1

DOI https://doi.org/10.11477/mf.1406900357

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Abstract 文献概要
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　くも膜下出血後に合併する低Na血症の発生機序として低張性脱水の重要性が報告されている。脱水は脳血管攣縮（以下VS）の増悪因子であることから，低Na血症とVS発生の関係を明らかにすることを目的とした。対象は過去3年間に入院した破裂脳動脈瘤121例で，VSは脳血管写所見，臨床症状，CT上のLDAで評価した。低Na血症は19例（15.7％）に発生し，19例中脳血管写上VSは15例，症候性VSは16例，CT上のLDAは8例に認められ，各々低Na血症非発生例と比較し，有意に高率であった。低Na血症が発症し，かつ症候性VSを認めた16例中低Na血症発生直前に多尿を認める症例が14例を占めた。また，低Na血症がVSに先行する症例は4例しかなく，低Na血症からVSの発生を予測することは困難であった。低Na血症合併例では脱水状態の存在が疑われ，VSの発生率が高く，その病態を考慮すれば積極的な補正は重要と思われる。

We studied retrospectively the relationship between hyponatremia and cerebral vasospasm in 121 consecutive patients with aneurysmal subarach-noid hemorrhage.

In 19 patients sodium levels fell below 130 mEq/l on at least two consecutive days. Hyponatremia developed at average 8.9 hospital day and lasted for 4.4 days. It was mild (126 to 130 mEq/l) in 15 patients, moderate (121 to 125 mEq/l) in 3 patients,and severe (116 to 120 mEq/l) in 1 patient. Cerebral vasospasm was evaluated by angiography, symp-toms and CT finding. Angiographical vasospasm was found in 57 patients, symptomatic vasospasm in 38 patients and low density area on CT in 20 patients.

Angiographical vasospasm developed in 15 of the 19 patients (78.9%) with hyponatremia, sympto-matic vasospasm in 16 patients (84.2%), low density area on CT in 8 patients (42.1%), the difference being significantly high. (respectively, p ＜0.01, p＜0.001 and p＜0.01 by chisquare test) Polyuria of 2500 ml or more immediately before the onset of hyponatremia developed in 14 patients (87.5%).

When symptomatic vasospasm and hyponat-remia coincided, there were only 4 patients in which symptomatic vasospasm was preceded by hypona-tremia. So, it is difficult to predict the development of vasospasm from that of hyponatremia.

This study found incidence of cerebral vasospasm after aneurysmal subarachnoid hemorrhage to be significantly higher in patients who developed hyponatremia, which raised suspicion about the presense of dehydration.

Hyponatremia with central origin generally remains asymptomatic, but it is important to treat positively when the pathology of cerebral vaso-spasm is taken into consideration.