抄録
Cerebral salt wasting syndrome (CSWS) is defined as the renal loss of sodium associated with intracranial diseases (e.g., aneurysmal subarachnoid hemorrhage [SAH]) that leads to hyponatremia and decreased extracellular fluid volume. CSWS increases the risk of symptomatic vasospasm (SVS) in SAH patients. To prevent SVS, CSWS was managed by administering physiological saline and sodium chloride so as to maintain a positive water balance and serum sodium level of >140 mEq/l.
The study population comprised 115 patients; the above-mentioned treatment was administered just after surgery, which was performed within 72 h after SAH. SVS occurred in 7 patients (6.09%): 5 (4.35%) presented with permanent deficits and 2 (1.74%) with transient deficits. Further, SVS occurred within a week in 6 of these patients.
On Day 2, the accumulative water balance was significantly higher in the non-SVS group than in the SVS group; the water balance tended to decline in the SVS group for a few days. Until Day 6, the amount of sodium chloride administered to maintain the serum sodium level to >140 mEq/l was higher in the SVS group than in the non-SVS group. However, on Days 3-5, the serum sodium level was lower in the SVS group than in the non-SVS group.
The use of physiological saline and sodium chloride therapy to maintain a positive accumulated water balance and control the serum sodium level in the management of CSWS, especially within the initial 7 days after SAH, can effectively prevent SVS.
