托伐普坦在垂体腺瘤围术期血钠管理中的临床评价

Evaluation of tolvaptan in perioperative sodium management of pituitary adenoma

目的:评估垂体腺瘤患者围术期短时应用低剂量托伐普坦进行血钠管理的有效性、安全性和经济性。方法:采用回顾性研究方法,利用医院信息系统提取2021年1月1日-6月30日我院神经外科收治的进行经鼻蝶窦入路神经内镜切除术的垂体腺瘤患者信息,按照治疗方式分为标准治疗组和托伐普坦组,收集患者的基本信息、治疗信息和实验室检查结果,分析两组患者的血钠变化情况、药品不良反应、住院时长和日均药费的差异。结果:纳入患者47例,标准治疗组23例,托伐普坦组24例。两组除血钠变化外实验室检查无差异,托伐普坦组血钠升高与标准治疗组有显著性差异,且血钠升高的人数更多(P<0.05)。多元Logistic回归显示血钠升高与托伐普坦治疗相关(OR:120.9,95%CI:2.73~5350.34,P=0.013)。两组患者的其余治疗、不良反应、住院时长和日均药费均无差异。结论:利用短时、低剂量托伐普坦进行垂体腺瘤围术期血钠管理,可以有效提高血钠水平,安全性良好,且不会延长住院时间和增加日均药费。

Objective:To evaluate the effectiveness,safety and economy of short-term application of low-dose tolvaptan in blood sodium management for pituitary adenoma during the perioperative period.Methods:Patients with pituitary adenoma who underwent neuroendoscopic resection via transnasal sphenoidal approach in the department of neurosurgery in our hospital from January 1st 2021 to June 30th were retrospectively included and were divided into the standard group and the tolvaptan group according to the treatment method.The general information,treatment and laboratory test results of the patients were collected and analyzed in terms of blood sodium,adverse drug reaction(ADR),length of hospitalization and average daily drug costs.Results:A total of 47 patients were enrolled,among which 23 cases were in the standard group,and 24 cases were in the tolvaptan group.There was no difference in laboratory tests between the two groups except for blood sodium.The rise of blood sodium in the tolvaptan group was significantly higher than that of the standard group,and there were more patients with increased blood sodium in the tolvaptan group(P<0.05).Multivariate Logistic regression showed that the rise of serum sodium was associated with tolvaptan(OR:120.9,95%CI:2.73-5350.34,P=0.013).There were no differences in the other treatments,ADR,length of hospitalization and average daily drug costs between the two groups.Conclusion:The use of short-term,low-dose tolvaptan for perioperative blood sodium management in pituitary adenoma could effectively and safely increase blood sodium value without increasing the length of hospitalization and average daily drug costs.