鞍区肿瘤术后钠代谢紊乱的相关因素及对策  

Correlative factors and countermeasures of sodium metabolic disturbance after surgery of sellar tumor

作　　者：刘汉[1] 霍钢[1] 杨刚[1] 王晓澍[1] 郑履平[1] 

机构地区：[1]重庆医科大学附属第一医院神经外科,重庆400016

出　　处：《检验医学与临床》2015年第6期721-722,726,共3页Laboratory Medicine and Clinic

基　　金：国家临床重点专科建设项目经费资助(财社[2011]170号)

摘　　要：目的探讨鞍区肿瘤术后影响钠盐紊乱的相关因素及对策。方法回顾性分析2011年1月至2014年4月收治的468例鞍区肿瘤患者术后的临床资料,从肿瘤类型、大小及手术方式等方面探讨鞍区肿瘤术后钠盐紊乱的发生情况。结果不同手术方式及鞍区肿瘤类型的高钠血症发生率比较差异均有统计学意义(P<0.01);且垂体腺瘤的不同手术方式及肿瘤大小间高钠血症发生率比较差异均有统计学意义(P<0.05);但鞍区肿瘤不同手术方式、肿瘤类型间低钠血症的发生率比较差异均无统计学意义(P>0.05)。不同肿瘤类型、手术方式间抗利尿激素分泌不当综合征(SIADH)及脑性盐耗综合征(CSWS)的发生率比较差异均无统计学意义(P>0.05)。结论鞍区肿瘤中开颅、颅咽管瘤、巨大垂体腺瘤术后易并发高钠血症,早期、正确鉴别SIADH和CSWS,良好的手术技巧及术后2周内对电解质情况的严密监测,是治疗鞍区肿瘤术后钠盐紊乱的关键。Objective To explore the factors influencing the sodium metabolic disturbance after resection of sellar tumor and the countermeasures.Methods The postoperative clinical data in 468 patients with sellar tumor treated from Jan.2011 to Apr.2014 were retrospectively analyzed and the occurrence situation of postoperative sodium metabolic disturbance was investigated in the aspects of the tumor type,size,surgical approach and so on.Results The occurrence rates of hypernatremia after the resection of sellar tumor had statistical differences among different surgical modes and tumor types（P〈0.01）;moreover the occurrence rates of postoperative hypernatremia in pituitary adenoma had statistical difference among different operation modes and tumor size（P〈0.05）;but the occurrence rate of hyponatremia in sellar tumor had no statistical difference among different operation modes and tumor types（P〉0.05）.The occurrence rates of the syndrome of inappropriate antidiuretic hormone secretion（SIADH）and cerebral salt wasting syndrome（CSWS）had no statistical differences among different tumors and operation modes（P〉0.05）.Conclusion Hypernatremia easily occurred after open microsurgery of sellar tumor,craniopharyngioma and giant pituitary adenoma.Early and correct identification of SIADH and CSWS,better operation skill and strictly monitoring electrolytes situation within postoperative 2 weeks are the key to treat postoperative sodium metabolic disturbance in sellar tumor.

关 键 词：鞍区肿瘤 高钠血症 脑性盐耗综合征 抗利尿激素分泌不当综合征 

分 类 号：R473.73[医药卫生—护理学]