蝶鞍区肿瘤手术后低钠血症的诊断和治疗

The Diagnosis and Management of Hyponatremia Following Removal of Tumors in Sellar Region

背景与目的:大型复杂的鞍区肿瘤手术后低钠血症的发生率比较高,主要以脑性耗盐综合征(cerebral salt-wasting syndrome,CSWS)和抗利尿激素分泌不适当综合征(the syndrome of inappropriate secretion of antidiuretic hormone,SIADH)为主,它们的临床表现相似但治疗原则相反,如果误诊常使病情恶化。本研究探讨低钠血症的有效诊断和治疗方法。方法:回顾分析长海医院神经外科1999年3月至2007年12月鞍区肿瘤手术后出现的低钠血症57例的临床资料。结果:在57例低钠血症患者中,56例血钠和血容量恢复,3～5d血钠纠正至正常,按24h尿钠检测结果补充钠,维持正常血钠水平,均获得痊愈出院。其中SIADH误诊为CSWS23例。1例由于血钠纠正过快而死于广泛性脑肿胀。结论:鉴别脑性耗盐综合征和抗利尿激素分泌不适当综合征,是治疗鞍区肿瘤手术后低钠血症的关键。血浆渗透压和中心静脉压测定对病情的判断有重要的价值。

BACKDROUND & OBJECTIVE:Hyponatremia is a common post-operative complication of large tumors involving sellar region, which is mostly attributed to either cerebral salt-wasting syndrome (CSWS)or the syndrome of inappropriate secretion of antidiuretic hormone(SIADH). The two sydromes are similar as clinical features, but with entirely different principles of treatment. In this study, we explored the differential diagnosis and effective treatment for postoperative hyponatremia. METHODS: The clinical data of 57 patients with hyponatremia after sellar surgery in our department, from March 1999 to December 2007, were collected and analyzed retrospectively. RESULTS: Among 57 cases, blood volume and serum sodium level of 56 cases returned to the normal level within 3-5 days, with strictly controlled fuild and sodium intake according to the 24h urinary sodium monitoring results. In this series, 23 cases with SIADH were misdiagnosed as CSWS. One case died of diffuse cerebral edema due to fast sodium restoration. CONCLUSION: Differential diagnosis between CSWS and SIADH is the key to treat the hyponatremia after sellar surgery. Monitoring plasma osmotic pressure and central venous pressure is valuable on themanagement of hyponatremia.