Correlation of disturbance of electrolyte balance with outcome of disorders of consciousness in patients with primary brainstem hemorrhage

Juan SUN; Shiyi ZUO; Zhenzhen CHEN; Guofang LIU; Hanxu CAI; Zhi HU; Yong LIU; Zhongxiang YAO

doi:10.16016/j.1000-5404.202102102

您当前的位置：

首页 >

文章列表页 >

Correlation of disturbance of electrolyte balance with outcome of disorders of consciousness in patients with primary brainstem hemorrhage

Monographic Reports : Basic and clinical studies for disorders of consciousness | 更新时间：2026-01-09

- Correlation of disturbance of electrolyte balance with outcome of disorders of consciousness in patients with primary brainstem hemorrhage
- Journal of Third Military Medical University Vol. 43, Issue 15, Pages: 1424-1429(2021)
- 作者机构：
  
  1.400037 重庆，陆军军医大学(第三军医大学)第二附属医院: 疼痛与康复医学科
  2.400037 重庆，陆军军医大学(第三军医大学)第二附属医院: 放射科
  3.400038 重庆，陆军军医大学(第三军医大学)基础医学院生理学教研室，脑与智能研究院
- 作者简介：
- 基金信息：
  
  the Fund for Creative Research Groups of National Natural Science Foundation of China(31921003)
- DOI：10.16016/j.1000-5404.202102102
  CLC： R363.13;R743.34;R749.13
- Received：21 February 2021，
  
  Revised：2021-06-04，
  
  Published：15 August 2021
- 稿件说明：
移动端阅览
Juan SUN, Shiyi ZUO, Zhenzhen CHEN, et al. Correlation of disturbance of electrolyte balance with outcome of disorders of consciousness in patients with primary brainstem hemorrhage[J]. Journal of Third Military Medical University, 2021, 43(15): 1424-1429.
DOI：

Juan SUN, Shiyi ZUO, Zhenzhen CHEN, et al. Correlation of disturbance of electrolyte balance with outcome of disorders of consciousness in patients with primary brainstem hemorrhage[J]. Journal of Third Military Medical University, 2021, 43(15): 1424-1429. DOI： 10.16016/j.1000-5404.202102102.

摘要

目的

探讨患者原发性脑干出血后电解质紊乱的特点及其与意识障碍转归的相关性。

方法

从陆军军医大学第二附属医院2010年1月1日至2020年9月1日收治的350例脑干出血患者中筛选出原发性脑干出血并进行标准化补液病例47例，根据意识状态分为无意识障碍组(

=21)、意识障碍组(

=21)和意识障碍转清醒组(

=5)，收集全病程静脉血钠离子、钾离子、氯离子、阴离子间隙(AG)和二氧化碳(CO

)含量的检测结果，分析其均值、最大值、最小值、异常率、平均波动幅度等指标的变化规律和特点，并探讨其与意识障碍患者转归的关系。

结果

单因素方差分析进行组间比较发现，在无意识障碍组、意识障碍组和意识障碍转清醒组之间，氯离子、阴离子间隙的均值、最大值、最小值、异常率和平均波动幅度差异均具有统计学意义(

0.05)；而钠离子、钾离子和CO

含量在上述3组之间，除CO

含量的异常率和平均波动幅度之外，差异均无统计学意义。进一步进行组内多重比较分析发现，与无意识障碍组比较，氯离子和阴离子间隙在意识障碍组的均值、最大值、异常率和平均波动幅度均显著升高，而最小值显著降低(

0.01)；钾离子、阴离子间隙、CO

含量在意识障碍转清醒组的异常率和平均波动幅度均显著升高(

0.01)，而钠离子和氯离子的差异均无统计学意义。

结论

电解质紊乱与原发性脑干出血的意识障碍程度密切相关，尤其是氯离子和阴离子间隙的异常率和平均波动幅度越高，意识障碍就越严重。

Abstract

Objective

To investigate the characteristics of disturbance of electrolyte balance after primary brainstem hemorrhage (PBH) and their correlation with the outcome of patients with disorders of consciousness (DOC).

Methods

A retrospective survey was used to statistically analyze the clinical data of 350 patients with brainstem hemorrhage admitted to the Second Affiliated Hospital of Army Military Medical University from January 1

2010 to September 1

2020. With our strict inclusion and exclusion criteria

47 PBH cases undergoing standardized fluid replacement were screened out. Then they were divided into the non-DOC group (

=21)

DOC group (

=21) and DOC translating to non-DOC group (

=5) according to their state of consciousness. The quantities of venous blood electrolyte and carbon dioxide during the whole duration of hospital stay were collected

and then analyzed for the changes of sodium

potassium

chloride

anion gap (AG) and CO

. Next

we analyzed the rule and characteristics of the changes of mean value

maximum value

minimum value

abnormal rate

average fluctuation range and other indicators

and explored their relationship with PBH.

Results

One-way analysis of variance (ANOVA) showed that there were significant differences in the mean value

maximum value

minimum value

abnormal rate and average fluctuation range of chloride ion and AG among the 3 groups (

0.05). But in addition to the abnormal rate and average fluctuation range of CO

content

there were no statistical differences in the contents of sodium ion

potassium ion and CO

among the 3 groups. Further multiple intra-group comparative analysis indicated that the mean value

maximum value

abnormal rate and average fluctuation range of chloride ion and AG were signi

ficantly increased

while the minimum value was decreased in the DOC group than the non-DOC group (

0.01). The abnormal rate and average fluctuation range of potassium ion

AG and CO

content were significantly increased (

0.01)

but no statistical significance was seen in sodium and chloride in the DOC translating to non-DOC group than the non-DOC group.

Conclusion

The disturbance of electrolyte balance is closely associated with the DOC severity in PBH patients. The higher the abnormal rate of chloride ion and AG and the average fluctuation range are

the more severe DOC is.

关键词

Keywords

references

MÁRQUEZ M F, TOTOMOCH-SERRA A, BURGOA J A, et al . Abnormal electroencephalogram, epileptic seizures, structural congenital heart disease and aborted sudden cardiac death in Andersen-Tawil syndrome[J ] . Int J Cardiol, 2015, 180: 206-209. DOI:10.1016/j.ijcard.2014.11.157.

ASTAPENKO D, NAVRATIL P, POUSKA J, et al . Clinical physiology aspects of chloremia in fluid therapy: a systematic review[J ] . Perioper Med (Lond), 2020, 9(1): 40. DOI:10.1186/s13741-020-00171-3.

JUERGENSON I, ZAPPINI F, FIASCHI A, et al . Teaching neuroimages: neuroradiologic findings in pontine and extrapontine myelinolysis: clue for the pathogenesis?[J ] . Neurology, 2012, 78(1): e1-e2. DOI:10.1212/WNL.0b013e31823ed0b5.

KEE Y K, JEON H J, OH J, et al . Dyschloremia is associated with failure to restore renal function in survivors with acute kidney injury: an observation retrospective study[J ] . Sci Rep, 2020, 10(1): 19623. DOI:10.1038/s41598-020-76798-5.

THONGPRAYOON C, CHEUNGPASITPORN W, PETNAK T, et al . Hospital-acquired serum chloride derangements and associated in-hospital mortality[J ] . Medicines (Basel), 2020, 7(7): E38. DOI:10.3390/medicines7070038.

ACHINGER S G, AYUS J C. Electrolyte disturbances in chronic alcohol-use disorder[J]. N Engl J Med, 2018, 378(2): 202-203. DOI:10.1056/NEJMc1714331.

LIAMIS G, FILIPPATOS T D, LIONTOS A, et al . Serum osmolal gap in clinical practice: usefulness and limitations[J ] . Postgrad Med, 2017, 129(4): 456-459. DOI:10.1080/00325481.2017.1308210.

FIRSCHING R. Coma after acute head injury[J]. Dtsch Arztebl Int, 2017, 114(18): 313-320. DOI:10.3238/arztebl.2017.0313.

UCHYTILOVA E, PROTUS M, MERTA D, et al . Lack of impact of hyperchloremia in brain-dead organ donors on the onset of kidney allograft function in the recipients[J ] . Transplant Proc, 2017, 49(6): 1262-1269. DOI:10.1016/j.transproceed.2017.02.053.

GULEN M, SATAR S, AVCI A, et al . Methanol poisoning in Turkey: Two outbreaks, a single center experience[J ] . Alcohol, 2020, 88: 83-90. DOI:10.1016/j.alcohol.2020.07.002.

CHENG B H, LI D W, GONG Y Q, et al . Serum anion gap predicts all-cause mortality in critically ill patients with acute kidney injury: analysis of the MIMIC-Ⅲ database[J ] . Dis Markers, 2020, 2020: 6501272. DOI:10.1155/2020/6501272.

HANNON M J, THOMPSON C J. Hyponatremia in neurosurgical patients[J]. Front Horm Res. 2019;52: 143-160. DOI: 10.1159/000493244.

JANG S H, CHANG C H, JUNG Y J, et al . Relationship between impaired consciousness and injury of ascending reticular activating system in patients with intracer ebral hemorrhage[J ] . Stroke, 2019, 50(8): 2234-2237. DOI:10.1161/STROKEAHA.118.023710.

QUADE B N, PARKER M D, OCCHIPINTI R. The therapeutic importance of acid-base balance[J]. Biochem Pharmacol, 2021, 183: 114278. DOI:10.1016/j.bcp.2020.114278.

CARLIER L, VAN BELLEGHEM V, CROES K, et al . Gamma-hydroxybutyrate (GHB), an unusual cause of high anion gap metabolic acidosis[J ] . CJEM, 2018, 20(S2): S2-S5. DOI:10.1017/cem.2017.10.

DERVISHI A. A deep learning backcasting approach to the electrolyte, metabolite, and acid-base parameters that predict risk in ICU patients[J]. PLoS ONE, 2020, 15(12): e0242878. DOI:10.1371/journal.pone.0242878.

闫中峰, 夏文菁, 李红, 等. 血气分析对发作性意识障碍的鉴别诊断意义[J]. 中国实验诊断学, 2020, 24(2): 208-211.

YAN Z F, XIA W J, LI H, et al . Value of blood gas analysis parameters in the differential diagnosis of transient disorders of consciousness[J ] . Chin J Lab Diagn, 2020, 24(2): 208-211.

马德林. 影响脑出血预后的相关因素分析[J]. 大家健康(学术版), 2016, 10(6): 98-99.

MA D L. Analysis of related factors affecting prognosis of intracerebral hemorrhage[J]. Heal, 2016, 10(6): 98-99.

金文刚. 探讨脑出血急性期常规生化指标的变化在患者预后判断中的价值[J]. 大家健康(学术版), 2013, 7(4): 53.

JIN W G. To investigate the value of routine biochemical indexes in the prognosis of patients with acute cerebral hemorrhage[J]. Heal, 2013, 7(4): 53.

李凤增. 常用实验室指标对急性脑出血预后判断的回顾性研究[D]. 重庆: 重庆医科大学, 2010.

LI F Z. Retrospective study on prognosis of acute intracerebral hemorrhage with commonly used laboratory indicators[D]. Chognqing: Chognqing Medical University, 2010.

STERNS R H, THOMAS D J, HERNDON R M. Brain dehydration and neurologic deterioration after rapid correction of hyponatremia[J]. Kidney Int, 1989, 35(1): 69-75. DOI:10.1038/ki.1989.9.

FINDSEN A, ANDERSEN J L, CALDERON S, et al . Rapid cold hardening improves recovery of ion homeostasis and chill Coma recovery time in the migratory locust, Locusta migratoria[J ] . J Exp Biol, 2013, 216(Pt 9): 1630-1637. DOI:10.1242/jeb.081141.

YU J, MENG F X, HE F P, et al . Metabolic abnormalities in patients with chronic disorders of consciousness[J ] . Aging Dis, 2021, 12(2): 386-403. DOI:10.14336/AD.2020.0812.

FELLER D, VINANTE C, TRENTIN F, et al . The effectiveness of Median nerve electrical stimulation in patients with disorders of consciousness: a systematic review[J ] . Brain Inj, 2021, 35(4): 385-394. DOI:10.1080/02699052.2021.1887522.

LOWE R, FERRARI M, NASIM-MOHI M, et al . Clinical characteristics and outcome of critically ill COVID-19 patients with acute kidney injury: a single centre cohort study[J ] . BMC Nephrol, 2021, 22(1): 92. DOI:10.1186/s12882-021-02296-z.

UMBRELLO M, FORMENTI P, CHIUMELLO D. Urine electrolytes in the intensive care unit: from pathophysiology to clinical practice[J]. Anesth Analg, 2020, 131(5): 1456-1470. DOI:10.1213/ANE.0000000000004994.

RODRÍGUEZ-TRIVIÑO C Y, TORRES CASTRO I, DUEÑAS Z. Hypochloremia in patients with severe traumatic brain injury: a possible risk factor for increased mortality[J]. World Neurosurg, 2019: S1878-S8750(19)30119-6. DOI:10.1016/j.wneu.2019.01.025.

MULLAGURI N, BEARY J M, NEWEY C R. Early detection of brainstem herniation using electroencephalography monitoring-case report[J]. BMC Neurol, 2020, 20(1): 406. DOI:10.1186/s12883-020-01988-7.

Views

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Predictive value of CT signs for disorders of consciousness in patients with primary brainstem hemorrhage

Efficacy and clinical outcomes of different antiviral regimens in HBeAg/HBeAb double-positive patients with chronic hepatitis B

Synchronous HPV genotyping and quantification assay to predict the outcome of high risk HPV infection: report of 2 784 cases

High-risk factors for disorders of consciousness of hypoglycemia

Related Author

Dong ZHANG

Zhongxiang YAO

Yong LIU

Wenjie HUANG

Lei ZHANG

Shiyi ZUO

Zhenzhen CHEN

Juan SUN

Related Institution

Department of Radiology, Second Affiliated Hospital, Army Medical University (Third Military Medical University)

Department of Pain and Rehabilitation, Second Affiliated Hospital, Army Medical University (Third Military Medical University)

Department of Physiology, College of Basic Medical Sciences, Army Medical University (Third Military Medical University)

Department of Hepatology, Affiliated Three Gorges Hospital of Chongqing University

Department of Hepatobiliary Surgery, First Affiliated Hospital, Army Medical University (Third Military Medical University)

⁰