Intervention and prognostic study in patients with severe stroke complicated with plasma hyperosmolality / 中国脑血管病杂志

ABSTRACT

Objective: To explore the clinical value in the intervention of patients with severe stroke complicated with plasma hyperosmolality. Methods: Th irty-four patients with severe stroke (Glasgow coma score [GCS] ≤12 on admission), who complicated with plasma hyperosmolality were selected. The changes of plasma osmotic pressure before and after the intervention and its related factors, as well as the effect of interventional therapy on prognosis were observed dynamically by controlling fluid replacement, diuretic, and blood sugar. Results: The most common interventional measures for plasma hyperosmolality were to control the fluid replacement (85.3%), the secondly to control the dosage of osmotic diuretic (41.2%) and blood glucose level (41.2%. Before the intervention, plasma osmotic pressure, natrium intaking and blood glucose level were (321 ± 10), (146 ± 5), and (9.5 ± 2.8) mmol/L, respectively; after the intervention, they were reduced to (308 ± 18), (142 ± 7), and (7.5 ± 3.1) mmol/L, respectively. The in-hospital mortality in patients who were intervened successfully (plasma osmotic pressure reduced to normal levels) in hyperosmolality group was 15.8%, and it was significantly lower (P < 0.01) than that in patients (100%) who were intervened unsuccessfully (plasma osmotic pressure did not reduced to normal levels). Multifactor logistic regression analysis showed that the major risk factors that influenced the in-hospital mortality were the increase of plasma osmotic pressure, and the increase of acute physiology and chronic health evaluation II (APACHE II) scores. Conclusion: Reducing the plasma osmot ic pressure may improve the prognosis in patients with severe stroke complicated with plasma hyperosmolality, and reduce the in-hospital mortality.