垂体腺瘤患者围手术期低钠血症的影响因素分析  

Influencing factor analysis of perioperative hyponatremia in patients with pituitary adenoma

作　　者：林昆哲 秦勇 魏梁锋 黄银兴 王守森 肖德勇 Lin Kunzhe;Qin Yong;Wei Liangfeng;Huang Yinxing;Wang Shousen;Xiao Deyong(Department of Neurosurgery,the First Hospital of Fuzhou City Affiliated to Fujian Medical University,Fuzhou 350009,China;Department of Neurosurgery,the 900 Hospital of Joint Logistics Team,Fuzhou 350025,China;Department of Neurosurgery,the Second Affiliated Hospital of Xiamen Medical College,Xiamen 362100,China)

机构地区：[1]福建医科大学附属福州市第一医院神经外科,350009 [2]联勤保障部队第九00医院神经外科,福州350025 [3]厦门医学院附属第二医院神经外科,厦门362100

出　　处：《中华神经外科杂志》2019年第5期489-493,共5页Chinese Journal of Neurosurgery

基　　金：福建省科技计划引导性项目(2018Y0067);南京军区福州总医院创新团队项目(2014CXTD07);福建省自然科学基金(2015D014);福建医科大学启航基金一般项目(2017XQ1193).

摘　　要：目的探讨垂体腺瘤患者围手术期低钠血症的影响因素。方法回顾性分析联勤保障部队第九○○医院神经外科2012年3月至2015年3月收治的164例垂体腺瘤患者的临床资料,所有患者行经鼻蝶入路手术切除肿瘤。采用单因素分析和多因素logistic回归分析探讨影响术前、术后低钠血症发生的相关因素。结果164例患者中,术前存在低钠血症10例(6.1%)。2例术前存在低钠血症者发生症状性垂体卒中。术后发生低钠血症37例(22.6%)。多因素logistic分析结果表明,术前肾上腺轴功能低下是术前发生低钠血症的危险因素(OR=6.738,95%CI:1.292~35.146,P=0.024);术前甲状腺轴功能低下(OR=2.735,95%CI: 1.149~6.511,P=0.023)为术后发生低钠血症的预测因素。结论垂体腺瘤患者围手术期发生低血钠时,应重视肾上腺轴和甲状腺轴的功能。对于症状性垂体卒中患者,术前应密切观察垂体功能及电解质水平。Objective To investigate the factors influencing perioperative hyponatremia in patients with pituitary adenomas. Methods We retrospectively analyzed the clinical data of 164 patients with pituitary adenomas admitted to Department of Neurosurgery, the 900 Hospital of Joint Logistics Team from March 2012 to March 2015. All patients underwent transsphenoidal approach to remove the tumor. The factors influencing hyponatremia were explored by univariate analysis and multivariate logistic regression analysis. Results Of 164 patients with pituitary adenomas, 10(6.1%) had hyponatremia before operation. Classical pituitary apoplexy occurred in 2 patients who had hyponatremia preoperatively. There were 37 cases of hyponatremia occurring after transsphenoidal surgery. Logistic multivariate analysis indicated that preoperative hypoadrenal axis dysfunction was a risk factor for preoperative hyponatremia (OR=6.738, 95%CI: 1.292-35.146, P=0.024), while preoperative hypothyroidism (OR=2.735, 95%CI: 1.149-6.511, P=0.023) was the predictive factor for postoperative hyponatremia. Conclusions The functions of adrenal gland axis and thyroid gland axis should be stressed when low blood sodium occurs in perioperative period in patients with pituitary adenomas. For patients with classical pituitary apoplexy, pituitary function and electrolyte levels should be closely monitored before surgery.

关 键 词：垂体腺瘤 低钠血症 垂体功能 危险因素 

分 类 号：R736.4[医药卫生—肿瘤]