鞍区肿瘤术后低钠血症的临床研究  

Clinical analysis of hyponatremia after surgical treatment of sellar tumors

作　　者：高寒[1] 王伟民[1] 蒋晓星[1] 白红民[1] 李天栋[1] 张小鹏[1] 王国良[1] 王玉宝[1] 杨帅[1] 

机构地区：[1]广州军区广州总医院神经外科,广州510010

出　　处：《中华神经医学杂志》2007年第8期829-831,共3页Chinese Journal of Neuromedicine

摘　　要：目的探讨鞍区肿瘤术后低钠血症的发生规律及其针对不同综合征的治疗方法。方法本组42例鞍区肿瘤患者入院后皆行鞍区肿瘤切除术,对术前及术后的血钠、尿钠、尿比重、中心静脉压等指标进行连续监测,根据诊断标准分辨出抗利尿激素分泌不当综合征(SIADH)及脑性盐耗综合征(CSWS),并根据不同诊断进行相应的治疗,其中CSWS患者分成应用及未应用氢化可的松两组。比较两种不同治疗方法的效果。结果42例患者中11例出现不同程度的低钠血症,其中垂体腺瘤9例,颅咽管瘤2例。符合CSWS的8例,SIADH的3例。SIADH一般发生在手术早期,特别是3d以内,且伴有尿量的减少和尿比重增加;而CSWS出现较晚,一般在3d以后,不伴有尿量的减少和尿比重增加。CSWS的主要处理是钠和水的补充,辅以氢化可的松治疗的效果要好于单纯补充水钠。结论鞍区肿瘤术后CSWS较常见,水钠补充辅以氢化可的松治疗效果较好。Objective To study the occurrence rule ofhyponatremia after resection ofsellar tumors and explore the therapeutic approaches for the treatment of the two syndromes leading to hyponatremia. Methods There were a total of 42 cases with sellar tumors. All the hospitalized patients underwent resection of sellar tumors; the preoperative and postoperative indicators of serum sodium, urine sodium, urine specific gravity and central venous pressure （CVP） etc were monitored successively and respective therapeutic approaches were given to the patients with syndrome of inappropriate antidiuretic hormone secretion （SIADH） or cerebral salt wasting syndrome （CSWS）, diagnosed by the diagnositc criteria. Patients with CSWS were then divided into two subgroups, hydrocortisone-treated group and hydrocortisone non-treated group, and the efficacies of the two therapeutic approaches were compared. Results Eleven cases developed hyponatremia with different degrees, namely, 26.2% among the total 42 cases. Of these 11 cases, 9 were pituitary adenomas and 2 were craniopharyngiomas. Eight cases were in accord with the criteria of CSWS and 3 cases, in accord with that of SIADH. SIADH often occurred during the early period of the surgical operation, espeically within the first 3 d, usually with reduction in the amount of urine and increase in urine specific gravity. The primary treatment of CSWS was the replenishment of water and sodium, and treatment assisted by hydrocortisone was better than that with water and soium. Conclusion The patients undergoing resection of sellar tumors have a high incidence of CSWS. Favorable efficacies for treatment of CSWS can be achieved with water and salt replenishment accompanied with the injection ofhydrocortisone.

关 键 词：鞍区肿瘤 脑性盐耗综合征 抗利尿激素分泌不当综合征 氢化可的松 

分 类 号：R739.4[医药卫生—肿瘤] R591[医药卫生—临床医学]