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Objective To explore the risk factors of hyponatremia in postoperative patients with aneurysm and analyze the clinical characterstics in order to provide reference for clinic.Methods Participants included 120 patients who treated by aneurysm occlusion.Detailed recorded the patient's history and basic information.The patients with hyponatremia were in case group,and other patients were in control group.The risk factors of hyponatremia were analyzed.Results Forty-five patients (37.5％) occurred hyponatremia after operation.The level of natrium was (125.2 ± 10.1) mmol/L,the average time of appear hyponatremia was (8.2 ± 0.8) d,15 patients were in the first peak(postoperative 1-3 d),25 patients were in the second peak (postoperative 8-9 d),5 patients occurred hyponatremia at other time.Thirty-nine patients were internal carotid artery aneurysms,6 patients were vertebrobasilar artery aneurysms.Single factor analysis showed that the age,preoperative GCS scores,history of hypertension and diabetes,emergency operation,the size of arterial aneurysms,medium-sized aneurysm of artery between two groups had significant difference [(48.7 ± 8.4) years vs.(54.7 ± 8.4) years,(14.4 ± 3.1) scores vs.(10.3 ± 3.4)scores,26.7％ (20/75) vs.60.0％ (27/45),33.3％ (25/75) vs.62.2％ (28/45),32.0％ (24/75) vs.62.2％(28/45),(0.9 ±0.3) cm vs.(1.4 ±0.4) cm,24.0％(18/75) vs.42.2％(19/45),P ＜ 0.01 or ＜ 0.05].Multifactors regression analysis showed that preoperative GCS scores,emergency operation were the independent risk factors of hyponatremia (P＜ 0.05).Conclusions Postoperative 1-3 d and 8-9 d are the peak stage of hyponatremia.Different treatment should be adopted according the peak stage.Lower scores of preoperative GCS and emergency operation are the independent risk factors of hyponatremia.Clinical work need to pay more attention to the risk factors,appropriate treatment and prevention.
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ObjectiveTo investigate the role of electroencephalogram (EEG) examination in the prognosis evaluation of patients with severe craniocerebral injury.MethodsFifty-seven patients with severe craniocerebral injury were selected as study subjects and their clinical data were analyzed retrospectively.All the patients got EEG examination,and the relationships between EEG grading and Glasgow coma scale (GCS) score,the prognosis of outcome were analyzed.ResultsThe EEG of 57 patients within 24 h after hospitalization were all abnormal.There was significantly negative correlation between EEG grading and GCS score (r =-0.742,P ＜0.05).EEG grading was significantly positively correlated with the prognosis of outcome (r =0.730,P＜ 0.05).ConclusionsEEG examination and EEG grading can evaluate the prognosis of patients with severe craniocerebral injury.It provides reference for clinical treatments.
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Objective To summarize the experience of prevention and treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH). Methods Fifty-eight cases with aneurysmal SAH were taken as study objects and their clinical data were retrospectively analyzed. All the patients with intracranial aneurysm undergoing Guglielmi detachable coils (GDC) or mechanical detachable coils (MDC)embolization were treated comprehensively by papaverine solution lavage in surgical field during intracranial aneurysm surgery,lumbar continued drainage of cerebrospinal fluid, nimodipine infusion continuously and blood pressure increasing,blood volume improving,blood diluting (3H) therapy after operation. Results Among the total 58 cases of SAH, 8 patients occurred cerebral vasoapasm ( 13.8%),mainly included 4 cases of transient paralysis,2 cases of unconsciousness dcepened,2 cases of transient aphasia,after active treatment,the motor function, disturbance of consciousness and language functions all restored with none in plant state or died. Conclusion Detachable coil embolization underwent in earlier period and then drained cerebrospinal fluid, infusioned nimodipine, taken 3H therapy and so on are the effective measures for preventing and treating cerebral vasospasm after SAH.
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Objective To investigate the influence of different interventional treatment timing on the prognosis of patients with intracranial aneurysms. Methods One hundred and thirty-eight patients with ruptured intracranial aneurysms were divided into group A (Ⅰ- Ⅲ grade) with 109 cases and group B ( Ⅳ- Ⅴ grade) with 29 cases according to Hunt-Hess grade when admitted. All patients received interventional treatment, the operation period was divided into early, middle and late stage according to the different time from disease time to operation, then compared the good rate, cerebral vasospasm and hydrocephalus incidence of patients underwent surgery at different period. Results The good rate at different period in group A were respectively 69.7% (23/33),58.8% (10/17) and 61.0% (36/59),which and the cerebral vasospasm and hydrocephalus incidence of patients underwent surgery at different period in group A had no significant difference(P > 0.05). The good rate of patients received surgical treatment at early stage in group B was 46.2%(6/13), which was significantly superior to late stage (0), the difference was statistically significant (P < 0.05), while the cerebral vasospasm and hydrocephalus incidence of patients underwent surgery at different period in group B had no significant difference(P> 0.05). Conclusion The prognosis of patients with Hunt-Hess grade Ⅰ - Ⅲ grade undergoing interventional treatment at early, middle and late stage can be satisfactory, while grade Ⅳ - Ⅴ grade patients should receive interventional treatment at early stage.
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Objective To investigate the dynamical changes of Rho kinase in the cerebrospinal fluid (CSF) and its relationship with cerebral vascular spasm CVS. Methods CSF were collected on the ist, 3rd, 7th, 10th and 14th day after subarachnoid hemorrhage. The expression of Rho-kinase mRNA in CSF was determined by RT-PCR. The expression of endothelin-1 in CSF was determined by radioimmuno-assay. TCD was used to measure the velocity of the cerebral artery. Results The levels of ET-1 and Rho-kinase mRNA in CSF were re-markably increased on the 3rd day, and reached at the peak on the 7th day after subarachnoid hemorrhage, which were significantly higher than those without CVS. Conclusion There is a positive correlation between the level of Rho-kinase mRNA and ET-1 in CSF. Rho-kinase may participate in the development of CVS.