颅脑肿瘤手术后低钠血症89例临床分析

目的 探讨颅脑肿瘤手术后发生低钠血症的可能发生原因、临床分类以及治疗体会.方法 统计653例颅脑肿瘤术后病例,术前血钠监测均正常,术后第2日始,每日监测血电解质,所有病例记录24小时出入液量,每日监测5次中心静脉压(CVP),鞍区肿瘤手术患者监测尿比重,记录每小时尿量.在血钠＜125mmol/L后,监测尿钠、血浆渗透压、尿渗透压.结果 653例中术后出现血钠偏低者122例,其中诊断为低钠血症89例.结论 结合颅脑肿瘤手术后低血钠发生可能机制,我们将低钠血症分为中枢性低钠、非中枢性低钠两种.非中枢性低钠的治疗,首先补盐,其次去除原发诱因.针对低血钠综合征,首先明确抗利尿激素分泌异常综合征(SIADH)和脑性盐耗综合征(CSWS)的诊断,治疗首先按照CSWS治疗有一定意义,如果效果不佳,考虑SIADH及其他治疗手段.

Hyponatremia analysis of 89 postoperative cases about brain turmor

Objective To discuss the possible reasons of hyponatremia after craniotomy about intracranial tumors. And to make clinic classification and get therapy experience. Methods 653 intracranial tumors patients with craniotomy were studied , the preoperative level of blood sodium is normal. The electrolyte and the sodium in blood were measured everyday after operation, all patients were Hgidly recorded the 24h input and output, and measure CAP five times every day. all of the patients of sellar tumor were measured about urinary specific gravity and urine output perh. When blood sodium was below 125mmol/L,the urinary electrolytes, plasma osmotic pressure, urine osmolality would be monitored. Results 122 patients among 653 cases had the low side serum sodium, 89 patients with hyponatremia. Conclusion According to the etiology of hyponatremla after operation, the hyponatrermla is classified central hyponatremia and not central hyponatremia. the central hyponatremia is cured by adequate supplement of salt and removal the inducement. To make SIADH and CSWS being distinguished clear is important for curing hyponatremla syndrome. That the primo is cured according to CSWS is to have certain meaning. Think about SIADH or other method, if the effect is not nice.