鞍区肿瘤术后低钠血症的临床处理

Clinical treatment of postoperative hyponatremia patients with sellar region tumors

目的探讨鞍区肿瘤术后抗利尿激素分泌异常综合征(SIADH)及脑性盐耗综合征(CSWS)的鉴别诊断及治疗方法。方法回顾性分析86例首次接受鞍区肿瘤术后低钠血症患者的临床表现和实验室检查,总结有效的诊断及治疗方法。将48例垂体腺瘤患者分为A组,28例颅咽管瘤和10例脑膜瘤患者分为B组;CSWS低钠者补钠、迅速扩容、补充高渗盐水,SIADH低钠者限水补盐利尿治疗。结果诊断为SIADH的39例,CSWS的47例。1例于术后8d死亡;1例出院后1个月发生低钠血症死亡;2例患者因水中毒出现抽搐、昏迷,对症治疗1个月后出院;余82例治疗后恢复良好。结论当鞍区肿瘤术后的患者合并低钠血症时应先排除医源性因素,细胞外容量是区别SIADH与CSWS的可靠指标,体质量及中心静脉压检测简单有效。

Objective To explore the diagnostic, and therapeutic methods of postoperative symdrome inappropriate secretion of antidiuretic hormone （SIADH） and cerebral salt-wasting syndrome （CSWS） of patients with sellar region tumors. Methods Clinical manifestation and laboratory examination of 86 postoperative hyponatremia patients with sellar region tumors were analyzed retrospectively, and effective diagnosis and treatment were summarized. Forty eight patients with pituitary adenoma were divided into group A, 28 patients with craniopharyngioma, and 10 patients with meningioma were divided into group B; CSWS with hyponatremia should be supplied with sodium, rapidly expanded, and added saline; SIADH should be done diuretic treatment by water restrictions and salt replacement . Results Among 86 case 39 cases were diagnosed with SIADH, and the rest 47 cases were diagnosed with CSWS. One patient died at the day 8 after surgery; one died of hyponatremia that happened after discharging one month later; two patients discharged after one month of treatment, who occurred convulsions and coma as a result of water intoxication. The rest 82 cases recovered well after symtomatic treatments. Conclusion For postoperative hyponatremia patients with sellar region tumors, latrogenic factors of cousing hyponatremia is firstly excluded; extracellular volume is a reliable indicator to make a distinction between SIADH and CSWS, detection of weight and central venous pressure （CVP） is easy and effective.