【作者】 曲志刚；

【导师】 赵丛海；

【作者基本信息】 吉林大学 ， 外科学， 2006， 硕士

【摘要】 目的研究蛛网膜下腔出血后不同损害方式对下丘脑的影响。方法回顾性研究了吉林大学中日联谊医院神经外科自1993年7月至2004年9月收治的242例动脉瘤性蛛网膜下腔出血患者的血钠变化,对比三脑室扩张与前交通动脉瘤合并三脑室积血对低钠血症和重度低钠血症的发生率的影响。结果共有139例(57.44%)发生了低钠血症,重度低钠血症的发生率为10.74%(26例)。合并第三脑室扩张的21例中,有16例发生了低钠血症,其中9例为重度低钠;在9例前交通动脉瘤合并第三脑室积血的病例中,7例发生了低钠血症,其中有1例为重度低钠;同时合并第三脑室扩张和第三脑室积血且动脉瘤位于前交通动脉的1例发生了轻度低钠血症。结论三脑室扩张与前交通动脉瘤合并三脑室积血对低钠血症和重度低钠血症发生率的影响无明显差别。同三脑室正常的病例相比,蛛网膜下腔出血后三脑室异常病例的低钠血症与重度低钠血症的发生率明显升高。更多还原

【Abstract】 The mortality and morbidity of intracranial aneurysm, which isthe most common cause of spontaneous subarachnoid hemorrhage(SAH), is high. Most intracranial aneurysms are located in Willisartery circle, and close to diencephalon and upper brain stem, andtheir rupture may lead to many clinical manifestations by damagingthe tissues around. The hypothalamus plays the main role inmaintaining the stabilization of the internal environment, and theimpairment of its structure and function will make the autonomicnervous system confused, such as the disturbance of the electrolytebalance. Most of the previous studies focused on the mechanisms ofthis confusion by analyzing the hormone levels, while it is rare thatthe article analyzing the hypothalamus’s damage by comparingkinds of lesions. This study will analyze the difference of thelesions to the hypothalamus, which is caused by the direct effect ofthe initial hemorrhage or mechanical compression, by comparingthe hyponatremia with the dilatation of the third ventricle and theintraventricular hemorrhage (IVH) of the third ventricle whoseaneurysms were found in the anterior communicating artery(ACoA).We retrospectively analyzed the serum sodium concentrationof 242 aSAH patients consecutively admitting to the NeurosurgeryDepartment of China-Japan Union Hospital of Jilin Universitybetween July 1993 and September 2004, and compared theinfluence on hyponatremia and severe hyponatremia held bydilatation and IVH of the third ventricle with ACoA aneurysms.Among the 242 patients, hyponatremia developed in 139(57.44%),severe hyponatremia in 26(10.74%). The CT scans showeddilatation of the third ventricle in 21 patients, of whomhyponatremia occurred in 16, severe in 9;IVH of the third ventriclewith ACoA aneurysms in 9, hyponatremia in 7, severe in 1;and 1with both dilatation and IVH of the third ventricle, whose aneurysmwas in ACoA, suffered hyponatremia.Our study showed that the influence on the incidence rate ofhyponatremia was similar between dilatation and IVH of the thirdventricle. And the difference on severe hyponatremia was notsignificant ether, but it seemed that the dilatation of the thirdventricle was more important. Comparing with the normal thirdventricle, the hyponatremia and severe hyponatremia occurredsignificantly more often in patients whose third ventricle wasabnormal (dilatation and/or IVH).It is still unclear about the relationship of hyponatremia andprognosis, and the results of researches don’t agree with each other.We didn’t analyze that relationship in this study. Some studiesshould be taken to compare the prognosis of SAH patients withnormal serum sodium levels and hyponatremia.更多还原