鞍区肿瘤术后高钠血症的转归及其严重程度的危险因素分析  

Analysis of outcome and severity risk factors of hypernatremia following the sellar tumor surgery

作　　者：陈亦豪 魏俊吉[1] 文俊贤 常健博 张笑[1] 姚勇[1] 冯铭[1] 包新杰[1] 幸兵[1] 连伟[1] 王任直[1] Chen Yihao;Wei Junji;Wen Junxian;Chang Jianbo;Zhang Xiao;Yao Yong;Feng Ming;Bao Xinjie;Xing Bing;Lian Wei;Wang Renzhi(Department of Neurosurgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peaking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院,北京协和医院神经外科,100730

出　　处：《中华神经外科杂志》2020年第8期775-779,共5页Chinese Journal of Neurosurgery

基　　金：国家重点研发计划(2018YFA0108603)。

摘　　要：目的分析鞍区肿瘤患者术后高钠血症的转归及影响其严重程度的危险因素。方法2016年1月至2018年12月中国医学科学院北京协和医院神经外科手术治疗2494例鞍区肿瘤患者,其中578例(23.2%)术后发生高钠血症。根据血钠增高程度将患者分为轻(533例)、中(30例)、重度(15例)组。回顾性分析578例鞍区肿瘤患者术后高钠血症的转归及影响其严重程度的危险因素。结果578例患者首次出现高钠血症的中位时间为术后第2天,541例(93.6%)在术后3 d内出现;74例(12.8%)出现阶段性低钠血症。出院前,295例(51.0%)血钠正常,267例(46.2%)为高钠血症,16例(2.8%)为低钠血症。441例(76.3%)患者发生尿崩症。出院前尿崩症治愈的192例中,98例(51.0%)血钠恢复正常;未治愈的249例中,128例(51.4%)血钠恢复正常;尿崩症治愈与未治愈者比较,出院时高钠血症的转归差异无统计学意义(P=0.801)。单因素分析结果显示,轻、中、重度高钠血症组比较,患者的性别、疾病类型、手术方式的构成比,术后发生尿崩症、颅内感染的比率,每日尿量、手术时间、术中出血量、肿瘤体积的差异均有统计学意义(均P<0.05)。多因素logistic回归分析显示,肿瘤体积大(OR=1.697,95%CI:1.241~2.318,P=0.001)、术后发生颅内感染(OR=3.661,95%CI:1.320~10.155,P=0.013)及库欣病(OR=3.366,95%CI:1.051~10.794,P=0.041)是影响患者术后高钠血症严重程度的独立危险因素。结论鞍区病变患者术后高钠血症的发生率较高,其中尿崩患者所占比例高,但对高钠血症的转归影响不大,且不是影响其严重程度的独立危险因素。肿瘤体积大、库欣病及术后颅内感染是影响术后高钠血症严重程度的独立危险因素。Objective To investigate the evolution of postoperative hypernatremia for sellar tumor patients and risk factors for the severity of hypernatremia.Methods From January 2016 to December 2018,a total of 2494 patients with sellar tumors underwent surgery at Department of Neurosurgery,Peking Union Medical College Hospital.Among them,578(23.2%)patients developed postoperative hyperna-tremia.The patients were divided into mild(533 cases),moderate(30 cases),and severe(15 cases)groups according to the severity of hypernatremia.We retrospectively analyzed the patient’s outcome and risk factors for the severity of hypernatremia.Results Of 578 patients,the median time for first development of postoperative hypernatremia was 2 days post operation.A total of 541 cases(93.6%)had hypernatremia within 3 days after surgery and included 74(12.8%)with hyponatremia for a certain period.Before discharge,295(51.0%)patients returned to the normal sodium level,267(46.2%)were diagnosed as hypernatremia and 16(2.8%)were diagnosed as hyponatremia.A total of 441(76.3%)patients developed diabetes insipidus(DI).Among the 192 DI patients whose DI was resolved,98(51.0%)patients returned to the normal sodium level.Among the remaining 249 patients whose DI was unresolved,128(51.4%)patients returned to the normal sodium levels.There was no significant difference in the outcome of hypernatremia between the DI-resolved group and DI-unresolved group(P=0.801).Univariate analysis revealed a significant difference between various severity groups of hypernatremia in sex ratio,disease type distribution,operation type distribution,incidences of DI and intracranial infection,urine volume,operation time,intraoperative blood loss,and tumor volume(all P<0.05).Multivariate analysis results indicated that large tumor(OR=1.697,95%CI:1.241-2.318,P=0.001),postoperative intracranial infection(OR=3.661,95%CI:1.320-10.155,P=0.013)and Cushing′s disease(OR=3.366,95%CI:1.051-10.794,P=0.041)were independent influencing factors for the severity of hypernatremia.Conclus

关 键 词：脑肿瘤 神经外科手术 高钠血症 治疗结果 危险因素 鞍区 

分 类 号：R739.41[医药卫生—肿瘤]