鞍区周围病变术后钠盐代谢紊乱临床分析

目的探讨鞍区及其周围病变术后钠盐代谢紊乱的类型、发病原因、发病机制及防治策略。方法回顾性分析河南省人民医院2008年10月—2012年11月收治的105例鞍区及其周围病变患者的临床资料。根据患者的临床表现和实验室检查将钠盐代谢紊乱分为高钠血症和低钠血症。比较同一种因素影响下分别出现高钠血症和低钠血症的发生率,用χ2检验进行统计分析。结果本组患者46例术后出现钠盐紊乱,发生率为43.81%;其中高钠血症24例,发生率为22.86%,低钠血症22例,发生率为20.95%。其中,垂体腺瘤向鞍上发展者29例,术后10例出现高钠血症,发生率为34.48%,1例出现低钠血症,发生率为3.45%(P<0.05);局限于鞍内者24例,术后1例出现高钠血症,发生率为4.17%,9例出现低钠血症,发生率为37.50%(P<0.05);颅咽管瘤20例,术后8例出现高钠血症,发生率为40.00%,3例出现低钠血症,发生率为15.00%(P<0.05)。下丘脑及三脑室区胶质瘤6例,术后2例出现高钠血症,发生率为33.33%,未出现低钠血症(样本量太小,未行统计学分析)。脑膜瘤9例,术后2例出现高钠血症,发生率为22.22%,3例出现低钠血症,发生率为33.33%(P>0.05)。鞍旁动脉瘤蛛网膜下腔出血者12例,术后1例出现高钠血症,发生率为5.88%,6例出现低钠血症,发生率为35.29%(P<0.05)。合并糖尿病患者37例,出现高钠血症12例,发生率为32.43%,出现低钠血症2例,发生率为5.41%(P<0.05)。结论鞍区周围病变术后易出现钠盐代谢紊乱,而垂体柄或下丘脑受侵及者及合并糖尿病患者术后钠盐紊乱多表现为高钠血症;未侵及垂体柄或下丘脑的鞍内病变患者、动脉瘤蛛网膜下腔出血患者多表现为低钠血症。

Analysis of sodium disorders after resection of affection in saddle and around saddle area

Objective To discuss the types, etiological factor, pathogenesis, treatment and outcome of sodium disorders after resection of affection in and around saddle area. Methods We retrospectively studied 105 patients＇ clinical data with affection in and around saddle area in the department of neurosurgery of the Henan Provincial People＇s Hospital between October 2008 and November 2012. We classified sodium disorders as hypernatremia and hyponatremia on the basis of clinical manifestation and result of laboratory examination. To compare the morbility of hypernatremia and hyponatremia caused by the identical factor. And then we made a statistic analysis of the morbility with chi square test（X^2） . That the value of P is less than 0.05 make sense in statitics （ P 〈 0.05 ）. Results There were （43.81%, 46/105 ） patients suffering from sodium disorders. In 46 cases,there were 24 cases （22.86% , 24/105 ） suffering from hypernatremia. 22 cases （20.95% , 22/ 105 ）suffering from hyponatremia. Among 29 cases with pituitary adenoma to grow to suprasellar or encroaching hypothalamus, 10 （34.48%, 10/29） showed hypernatremia, 1 （3.45%, 1/29） showed hyponatremia（ P 〈0.05）. Among 24 cases with pituitary adenoma in sellar , 1 （4.17%, 1/24） showed hypernatremia, 9 （37.50%, 9/24 ） showed hyponatremia （P 〈 0.05）. Among 20 patients with craniopharyngioma, 8 （40%, 8/20） showed hypernatremia, 3 （15%, 3/20） showed hyponatremia（ P 〈 0.05 ）. Among 6 patients with gliomas in hypothalamus and the third cerebral ventricle ,2 （33.33%, 2/6 ） showed hypernatremia, none showed hyponatremia （none statistic analysis ）. Among 9 patients with meningeoma, 2 （22.22% ,2/9） showed hypernatremia, 3 （ 33.33% , 3/9 ） showed hyponatremia （ P 〉 0.05 ）. Among 17 patients with aneurysms subaraehnoid hemorrhage, 1 （5.88% , 1/17） showed hypernatremia, 6 （35.29% , 6/17） showed hyponatremia （P 〈 0.05 ）. Among 19 gerontie patients, 1 （5.26%, 1/19 ） showed hypernatremia, 8 （42.11%, 8/19 ） showed hyponatremia（ P 〈 0.05 ）. Among 37 patients coinciding with diabetes, 12 （32.43% , 12/37） showed hypernatremia, 2（ 5.41% , 2/37 ） ca showed hyponatremia（ P 〈 0.05 ）. Conclusion Patients with affection in saddle and around area are subject to sodium disorders. The type of sodium disorders of patients suffering from tumors growing to suprasellar or encroaching hypothalamus and of patients coinciding with diabetes is more hypernatremia. The type of sodium disorders of patients suffering from tumors in sellar and aneurysms subarachnoid hemorrhage is more hyponatremia.