【作者】 姚庆；

【导师】 雷闽湘；

【作者基本信息】 中南大学 ， 内科学， 2012， 博士

【摘要】 目的分析颅脑肿瘤手术后连续5天水电解质尤其是血钠的改变,皮质醇(cortisol)及促肾上腺皮质激素(ACTH)的改变,探讨低钠血症的发生率及其严重程度、术后皮质醇功能障碍与肿瘤类型、手术方式及年龄的相关性。方法对2010年5月～2012年1月入住中南大学湘雅医院神经外科颅脑肿瘤患者的临床资料进行回顾性分析。收集进行了术前术后电解质和皮质醇检测的242例病例,术前血钠、皮质醇及ACTH均在正常范围内,术后第1天～术后第5天每日监测电解质,连续监测5天,术后在使用任何皮质醇激素类药物之前测血皮质醇及ACTH,并进行术前与术后皮质醇及ACTH的比较。所有病例记录24小时尿量及术后的补液方式,部分术后低钠血症的病例,为指导治疗进行中心静脉压(CVP)的测定。结果242例颅脑肿瘤患者中出现术后低钠血症者为119例,占总人数的49.17%。肿瘤类型、手术方式及年龄可影响术后低钠血症的发生率,但不能影响术后低钠血症的严重程度,术后低钠血症发生的高峰时间在不同类型肿瘤之间并无明显差别,大约在术后第3.88±1.116天。术后皮质功能障碍的发生率为59.4%,术后皮质功能障碍在不同颅脑肿瘤类型之间有显著性差异,开颅手术皮质功能障碍的发生率(68.30%)高于经鼻蝶鞍区肿瘤切除术(52.00%),但无统计学意义(P=0.058),不排除样本量不足所致。结论颅脑肿瘤术后易发生低钠血症和皮质功能障碍,<20岁颅咽管瘤行开颅手术的患者最易发生低钠血症,不同年龄患者因不同类型颅脑肿瘤行不同方式的手术后,低钠血症的严重程度均一致,低钠血症病例中部分可出现抗利尿激素分泌不恰当综合征(SIADH)和脑耗盐综合征(CSWS),进行中心静脉压以及尿渗透压的测定可予以鉴别。若诊断为SIADH,予以限液治疗,若为CSWS,治疗上则以补充血容量及补钠为主。开颅手术术后皮质功能障碍发生率较经鼻蝶鞍区切除术高,但无统计学意义,治疗上予以补充ACTH或外源性糖皮质激素。更多还原

【Abstract】 Objective To analyze the electrolyte after brain tumor surgery for five days, especially the change of serum sodium, cortisol and ACTH, discuss the incidence of hyponatremia, the severity of hyponatremia and the correlation with tumor type, surgical approach and age.Method To retrospective analyzed the data of patients with cerebral tumor who admitted to the Central South University of XiangYa Hospital neurosurgery in May2010to January2012.242cases had done the preoperative and postoperative electrolyte and cortisol testing. Preoperative serum sodium monitoring was all normal, the cortisol and ACTH within the normal range. Monitoring electrolyte in the postoperative1-5days continuously. Monitoring serum cortisol and ACTH before used any cortisol drug. Every patient should note the24hours urine volume and the fluid replacement way after operation. In some postoperative hyponatremia cases, central venous pressure determination was used to guide the treatment.Result119cases were diagnosed of postoperative hyponatremia in242cases of patients with brain tumor, accounting for49.17%of the total number of people. The type of cerebral tumor, surgical procedure and age produced an effect on the occurrence of postoperative hyponatremia, but not the severity of hyponatremia. There was no significant difference between the several types of cerebral tumor in the peak time of postoperative hyponatremia, about in the3.88±1.116th day after operation. The occurrence of postoperative cortical dysfunction was59.4%. The cerebral tumor type can influence the postoperative cortex dysfunction. The incidence of cortical dysfunction for craniotomy(68.30%) is higher than nose sellar tumor resection(52.00%), but no statistical significance(P=0.058). The reason is lack of sample size.Conclusion Hyponatremia and cortical dysfunction are easily happened after cerebral tumor surgery. The patients with craniophary-ngioma who are younger than20years old used craniotomy are more likely to get hyponatremia. The patients with different ages using the different surgical methods to treat the different types of cerebral tumor, the severity of hyponatremia is consistent. Some cases of hyponatremia is SIADH and CSWS, according to the postoperative blood volume and the balance of sodium metabolism to identify. If it is SIADH, limit the amount of liquid intake to treat this condition. Add volume and sodium can correct CSWS. The craniotomy is more likely to cause cortical dysfunction, but there is no statistical significance. The treatment is ACTH or exogenous glucocorticoid.更多还原