鞍区肿瘤术后合并脑性盐耗综合征的预后相关影响因素分析  

Analysis of Risk Factors in Postoperative Prognosis of Patients after Sellar Tumors Surgery with Cerebral Salt Wasting Syndrome

作　　者：王莎[1] 贺龙[1] 程丽萍[1] 李欣[1] 袁世君[1] 代巧英 贺恒旺[1] 常祥平[1] 

机构地区：[1]邯郸市第一医院神经内科,河北邯郸056002

出　　处：《神经损伤与功能重建》2016年第5期404-406,共3页Neural Injury and Functional Reconstruction

基　　金：河北省邯郸市科学技术研究与发展计划项目(No.1323108136)

摘　　要：目的:探讨鞍区肿瘤术后合并脑性盐耗综合征(CSWS)的预后相关影响因素。方法:鞍区肿瘤术后患者49例,按照是否发生CSWS分为单纯肿瘤术后组(SS)29例和术后合并CSWS(SC组)20例。随访1年,采用格拉斯哥预后量表(GOS)评价患者预后,Kaplan Meier法进行生存分析,Cox模型分析患者预后危险因素。结果:入院时,SC组血钠、血渗透压低于SS组(P<0.05),而24 h尿钠、24 h尿量、血清中心钠素(ANP)、脑钠肽(BNP)、皮质醇(HC)、醛固酮(AL)均高于该组(P<0.05)。随访1年后,SS组无死亡;SC组死亡5例,差异有统计学意义(P<0.05);GOS4分组BNP、HC、AL含量均低于<3分组(P<0.05);5分组ANP、BNP、HC、AL含量均低于<3分组、4分组(P<0.05)。Cox模型分析显示,鞍区肿瘤手术方式、肿瘤类型、血钠降低程度、中心静脉压(CVP)、ANP、BNP、HC、AL水平为鞍区肿瘤术后影响患者预后的危险因素(P<0.05或0.01)。结论:鞍区肿瘤术后合并CSWS患者ANP、BNP、HC、AL在治疗初期明显增高,肿瘤手术入路方式、肿瘤类型、血钠降低程度、CVP、ANP、BNP、HC和AL含量对患者的预后有着明显的影响。Objective： To investigate the risk factors in postoperative prognosis of patients after sellar tumors surgery with cerebral salt wasting syndrome （CSWS）. Methods： Forty-nine cases after sellar tumors surgery were enrolled, which were divided into SC group （n=20） and SS group （n=29） according to the occurrence of CSWS or not. All the cases were followed up for 1 year, and Glasgow outcome score （GOS） was used to evaluate the prognosis, Kaplan Meier was used to analyze the patients＇ survival, and Cox model was used to analyze the prognostic risk factors. Results： At the beginning of treatment, the serum sodium, serum osmolality in SS group were higher than those in the SC group （P〈0.05）, while the leves of 24 h urinary sodium, 24 h urine volume, atrial natriuretic peptide （ANP）, brain/B type natriure ticpeptide （BNP） and aldosterone （AL） were lower than those of the SC group （P〈0.05）. One year later, there was no death in the SS group and 5 cases died in the SC group （P〈 0.05）. The ANP, BNP, HC and AL levels in cases with GOS score 5 were lower than those in cases with score 3 and 4 （P〈0.05）. Cox model analysis showed that sellar tumors surgical approach way, tumor types, lower serum sodium level, central venous pressure （CVP）, ANP, BNP, HC and AL levels were the risk factors for prognosis of the patients after sellar tumors surgery （P〈0.05 or 0.01）. Conclusion： Tumor surgical approach way, tumor types, lower serum sodium level, CVP, ANP, BNP, HC and AL levels have significant impacts on the prognosis of patients.

关 键 词：鞍区肿瘤 脑性盐耗综合征 预后 分析 

分 类 号：R741[医药卫生—神经病学与精神病学] R741.05[医药卫生—临床医学]