儿童颅咽管瘤术后血钠水平的波动及其与癫痫发作的关系

Analysis of correlation between blood sodium fluctuation and epilepsy after craniopharyngioma operation in children

目的探讨儿童颅咽管瘤患者术后7 d内血钠水平的波动及其与癫痫发作的关系。方法回顾性分析74例颅咽管瘤手术患儿的临床资料。其中术后发生癫痫者6例(8.1%)。检测患儿术后当日、术后1~7 d及发生癫痫时的血钠浓度,血钠值正常范围为135~145 mmol/L。依据各时间点的血钠值将患儿分为4组,均在正常范围者为血钠正常组,持续性低钠血症者为低钠血症组,持续性高钠血症者为高钠血症组,既有高钠血症也存在低钠血症者为交替异常组。分析患儿术后7 d血钠波动状况及各组患儿的癫痫发生率。结果本组74例患儿术后1~3 d的平均血钠值均在正常范围;术后4~6 d的平均血钠值均低于正常,第4 d为低钠血症的高发时间点;术后第7 d平均血钠值恢复至正常水平。74例患儿中,交替异常组26例(35.1%),其中发生癫痫者5例(19.2%);低钠血症组9例(12.2%),发生癫痫者1例(11.1%);血钠正常组22例(29.7%),高钠血症组17例(23.0%),均无发生癫痫者。结论术后第4 d为颅咽管瘤患儿低钠血症的高发时间点;颅咽管瘤患儿术后血钠水平降低,更有可能导致癫痫发作。

Objective To investigate the fluctuation of blood sodium level in children with craniopharyngioma within 7 days after operation and its relationship with epilepsy.Methods The clinical data of 74 children with craniopharyngioma were analyzed retrospectively.Among them,6 cases(8.1%)had epilepsy after operation.The blood sodium concentration of children was measured on the day after operation,1-7 days after operation and epilepsy.The normal range of blood sodium was 135-145 mmol/L.According to the blood sodium value at each time point,the children were divided into four groups,all in the normal range were normal blood sodium group,the persistent hyponatremia group was hyponatremia group,the persistent hypernatremia group was hypernatremia group,and the patients with both hypernatremia and hyponatremia were the alternation abnormal group.The blood sodium fluctuation and epilepsy incidence of each group were analyzed 7 days after operation.Results The average blood sodium values of 74 cases were in the normal range from 1 to 3 days after operation.The average blood sodium values were lower than normal from 4 to 6 days after operation.The high incidence time of hyponatremia was the fourth day.The average blood sodium values returned to the normal level on the seventh day after operation.Of 74 cases,26 cases(35.1%)had alternation abnormality,among which 5 cases(19.2%)had epilepsy.9 cases(12.2%)had hyponatremia,and 1 case(11.1%)had epilepsy.22 cases(29.7%)had normal blood sodium,and 17 cases(23.0%)had hypernatremia.Conclusions The fourth day after operation is the high incidence time of hyponatremia in children with craniopharyngioma.The decrease of blood sodium level in children with craniopharyngioma after operation is more likely to lead to seizures.