鞍区肿瘤术后合并中枢性尿崩症患者的临床特点及护理对策

Clinical characteristics and nursing strategies in patients with saddle area tumors complicated with central diabetes insipidus after surgery

目的探讨鞍区肿瘤术后合并中枢性尿崩症患者的临床特点及护理对策。方法选取2015年1月至2016年12月间首都医科大学附属北京天坛医院收治的100例鞍区肿瘤手术患者,将45例术后合并中枢性尿崩症患者纳入观察组,55例术后未合并中枢性尿崩症患者纳入对照组,通过比较并观察两组患者围术期指标,探讨鞍区肿瘤术后合并中枢性尿崩症患者的护理对策。结果观察组患者术后24h尿量、24h尿钠、血渗透压、血钠和血浆心钠钛含量改善效果均高于对照组患者,差异均有统计学意义(均P<0.05)。但短暂性尿崩症患者格拉斯哥预后评分(GOS)平均分较持续性尿崩症患者高,且评分为5分患者例数也较持续性尿崩症患者多,差异均有统计学意义(均P<0.05)。短暂性尿崩症患者血浆中抗利尿激素水平可恢复至正常水平,持续性尿崩症患者仍低于正常水平。术后随访一年,短暂性尿崩症患者生存状况佳,持续性尿崩症患者死亡5例,差异有统计学意义(P<0.05)。结论鞍区肿瘤术后合并中枢性尿崩症患者的预后情况与24h尿量及血浆中抗利尿激素水平有关,不同类型的中枢性尿崩症患者生活质量存在一定差异,合并中枢性尿崩症患者的护理应具有系统性和综合性。

Objective To investigate the clinical characteristics and nursing strategies in patients with central diabetes mellitus after surgery. Methods One hundred patients undergoing surgery for saddle area tumors were selected at Being Tiantan Hospital Affiliated to Capital Medical University from January2015 to December 2016. Forty-five patients with central diabetes insipidus were included in the observation group and 55 patients without central diabetes insipidus were included in the control group. By comparing the perioperative indexes between the two groups,nursing strategies were identified. Results Compared with the control group,improvement in 24 h urine volume,urinary sodium,plasma osmotic pressure,serum sodium concentration and plasma atrial natriuretic titanium content were higher in the observation group than in the control group（ all P〈0. 05）. However,average GOS score was higher in patients with transient diabetes insipidus than patients with continuous diabetes insipidus and the number of patients with score of 5 was more in patients with transient diabetes insipidus than patients with continuous diabetes insipidus（ all P〈0. 05）. In patients with transient diabetes insipidus,the levels of plasma antidiuretic hormone can restored to normal levels while those with persistent diabetes insipidus are still below normal（ P〈0. 05）. After follow-up of one year,patients with transient diabetes insipidus had better survival and 5 patients died of persistent diabetes insipidus（ P〈0. 05）. Conclusion The prognosis of patients with saddle area tumors complicated with postoperative regional diabetes insipidus was correlated with 24 h urine output and plasma antidiuretic hormone levels. There were some differences in quality of life between patients with different types of central diabetes insipidus and nursing for patients with central diabetes insipidus of the care should be a systematic and comprehensive.