颅咽管瘤病人术后电解质水平变化特征及其影响因素分析

Characteristics and analysis of influencing factors of postoperative electrolyte level changes in patients with craniopharyngioma

目的 探讨颅咽管瘤病人术后早期电解质水平变化特征并分析其影响因素。方法 回顾性分析徐州医科大学附属医院2011~2020年颅咽管瘤手术病例资料,按年龄将病人分为老年组(14例)、中年组(25例)和青年组(43例),比较不同年龄组病人手术前、手术后1 d电解质及甲状腺激素水平变化特征,并分析其相关性。结果 3组性别差异有统计学意义(P=0.042),肿瘤分型、手术入路方式差异均无统计学意义(P>0.05)。本组颅咽管瘤病人术后1 d以高钠、低钙、低钾、高氯血症为主。老年组病人术后所有电解质水平均无明显变化(P>0.05)。青年组术后钾离子、钙离子水平低于术前,中年组钾离子、磷离子水平低于术前,差异均有统计学意义(P<0.05)。术后3组游离三碘甲状腺原氨酸(FT3)、超敏促甲状腺素(sTSH)水平均较术前显著下降,青年组术后游离甲状腺素(FT4)水平显著低于术前及中年组、老年组。相关性分析提示,氯离子术后变化水平与FT4术后变化水平呈负相关(r=-0.251,P=0.035),磷离子术后变化水平与FT3术后变化水平呈正相关(r=0.281,P=0.020)。结论 老年颅咽管瘤病人术后1 d电解质水平波动不大,术中需对垂体柄做好个性化处理,术后需做好对电解质的监测及激素替代治疗。

Objective To investigate the change characteristics of early postoperative electrolyte level in the patients with craniopharyngioma and to analyze the influencing factors.Methods The data of the cases of craniopharyngioma receiving surgery in the Affiliated Hospital of Xuzhou Medical University from 2011 to 2020 were analyzed retrospectively.According to the age,the patients were divided into elderly group(14 cases),middle-aged group(25 cases)and youth group(43 cases).The changes of electrolyte and thyroid hormone levels in different age groups before and one day after surgery were compared,and the correlations were also analyzed.Results There was significant difference in gender among the three groups(P=0.042),and there were no significant differences in tumor classification and surgical approach(P>0.05).The patients with craniopharyngioma in this study mainly showed hypernatremia,hypocalcemia,hypokalemia and hyperchloremia one day after surgery.There were no significant changes in the levels of all electrolytes in the elderly group after operation(P>0.05).One day after surgery,the levels of potassium and calcium in youth group and the levels of potassium and phosphorus in middle-aged group were significantly decreased,and the differences were statistically significant(all P<0.05).After operation,the levels of free triiodothyronine(FT3)and hypersensitive thyrotropin(sTSH)in the three groups were significantly lower than those before operation,and the level of free thyroxine(FT4)in youth group was significantly lower than that before surgery,and that in middle-aged group and elderly group.Correlation analysis showed that the level of chloride changed was negatively correlated with the level of FT4 changed(r=-0.251,P=0.035),and the level of phosphorus changed was positively correlated with the level of FT3 changed(r=0.281,P=0.020).Conclusions The levels of the electrolytes fluctuate little in the elderly patients with craniopharyngioma one day after surgery,and a personal management of pituitary stalk in the surgery is necessary.Electrolyte monitoring and hormone replacement therapy should be performed well after surgery.