预防性运用长效尿崩停对颅咽管瘤术后早期尿崩及血钠的影响  

Influence of preventive use of vasopressin tannate on diabetes insipidus and serum sodium at the early postoperation of craniopharyngioma

作　　者：熊涛[1] 王苟思义[2] 李学军[2] 刘庆[2] 蒋星军[2] 彭泽峰[2] 袁贤瑞[2] 

机构地区：[1]浙江大学医学院附属第四医院神经外科,浙江义乌322000 [2]中南大学湘雅医院神经外科,长沙410008

出　　处：《中南大学学报（医学版）》2016年第10期1058-1063,共6页Journal of Central South University ：Medical Science

摘　　要：目的:分析探讨预防性使用长效尿崩停(鞣酸加压素针)对颅咽管瘤开颅术后早期尿崩及血钠的影响。方法:回顾性分析2010至2014年行单侧额下开颅显微手术治疗的83例颅咽管瘤患者,分为预防性使用长效尿崩停组(使用组)和未使用组,对使用组及未使用组的术后早期尿崩情况及血钠变化趋势进行对比分析。结果:与未使用组比较,使用组整体术后早期尿崩的发生率少(P<0.05);垂体柄切除及肿瘤与三脑室底粘连紧密的患者术后尿崩发生率高(P<0.05),但在这两种情况中,使用组较未使用组术后早期尿崩的发生率少(P<0.05)。术后高钠者为37例(44.6%),术后出现低钠者共60例(72.3%),高钠、低钠出现的平均时间为术后1.4和3.7 d。术后高钠、低钠交替出现的有19例(22.9%)。使用组与未使用组在术后第1天血钠分布上差异有统计学意义(P<0.05),使用组术后第1天高钠出现百分比低于未使用组,差异有统计学意义(P<0.05)。结论:术中或术后早期预防性使用长效尿崩停可以有效减少颅咽管瘤患者术后早期尿崩及高钠血症的发生率。Objective： To explore the influence of preventive use of vasopressin tannate on diabetes insipidus and serum sodium at the early postoperation of craniopharyngioma.Methods： The data of 83 patients, who underwent unilateral sub-frontal approach resection of craniopharyngioma between 2010 and 2014 by the same senior neurosurgeon, were retrospectively analyzed, q-he patients were divided into a vasopressin tannate group （used group） and a control group. The diabetes insipidus and serum sodium changes were compared between the two groups. Results： Compared with the control group, the incidence of diabetes insipidus decreased at the early postoperation in the vasopressin tannate group （P〈0.05）. There was high incidence of diabetes insipidus in patients with pituitary stalk excision and tumor close adhesion to the third ventricle floor at the early postoperation （P〈0.05）. Under such conditions, the incidence of diabetes insipidus in the vasopressin tannate group was decreased compared with the control group （P〈0.05）. Postoperative hypernatremia occurred in 37 patients （44.6%）, and hyponatremia occurred in 60 patients （72.3%）, the average time of the occurrence ofhpernatremia and hyponatremia was 1.4 and 3.7 days after surgery. Postoperative high serum sodium and low serum sodium appeared alternately in 19 patients （22.9%）. There was significant difference in the serum sodium distribution in the first day after surgery in both groups （P〈0.05）, and the percent of hpematremia in the vasopressin tannate group was significantly less than that in the control group （P〈0.05）. Conclusion- Preventive use of vasopressin tannate can effectively reduce diabetes insipidus and hypernatremia incidence at the early postoperative stage after microsurgery for craniopharyngioma.

关 键 词：颅咽管瘤 显微手术 长效尿崩停 尿崩 血钠 

分 类 号：R739.4[医药卫生—肿瘤]