动态监测尿量和尿电解质在鞍区肿瘤术后水电解质管理中的应用

Postoperative Management of Patients with Sellar Tumors through Monitoring Urine Volume and Urine Electrolytes

目的探讨动态监测尿量和尿电解质在鞍区肿瘤患者术后水电解质管理中的价值。方法回顾性分析在四川大学华西医院行手术治疗的103例鞍区肿瘤患者的病历资料,其中56例患者(A组)根据血电解质水平进行术后水电解质管理,47例患者(B组)以尿量和尿电解质为主进行术后水电解质管理。分析两组患者的血、尿电解质和24h尿量,以及两组患者分层后的电解质紊乱情况。结果两组患者术后前3d血电解质正常,但有大量的电解质从尿中排出。术后第4～7d两组患者均有水电解质紊乱发生,B组水电解质紊乱发生率(17.02%,8/47)低于A组(73.21%,41/56),差异有统计学意义(P<0.05)。性别对两组患者术后水电解质的紊乱率无影响。A组颅咽管瘤患者、经颅手术患者术后血电解质紊乱率高于垂体瘤患者、经蝶手术患者(P均<0.05),而B组内差异无统计学意义(P均>0.05)。结论鞍区肿瘤患者术后单纯根据血电解质进行管理难于控制水电解质紊乱的发生,而根据尿量及尿电解质进行管理能有效降低水电解质紊乱的发生率,同时也能降低管理难度。

Objecitve To determine the value of urine volume and urine electrolytes in postoperative management of patients with sellar tumors. Methods Medical records of 103 patients with sellar tumors in the West China Hospital from January 2009 to December 2009 were retrospectively reviewed. The patients were managed either based on blood electrolytes （Group A, n=56） or based on urine volume and urine electrolytes （Group B, n= 47）. The incidence of balance disturbance of water and electrolytes was compared between the two groups. Results The levels of blood electrolytes were normal in both groups 3 days after operations despite significant loss of electrolytes through urine. Balance disturbance of water and electrolytes was revealed 4-7 days after operations. Group B had a lower incidence of balance disturbance of water and electrolytes （17.02%, 8/47） compared with Group A （73.21%, 41/56, P〈0.05）. No gender difference in the incidence of balance disturbance of water and electrolytes was found. Higher incidence of balance disturbance of water and electrolytes was found in craniopharyngioma （P〈0.05, vs. pituitary adenoma） and in the patients undergoing craniotomy （P〈0.05, vs. transsphenoidal approach） in Group A, but not in Group B. Conclusion Better management of balance disturbance of water and electrolytes can be achieved for patients with sellar tumors through monitoring urine than through blood. It can also simplify the postoperative management of patients with sellar tumors.