经蝶鞍区病变切除术术中及术后尿量及低钠血症关系.docVIP

经蝶鞍区病变切除术术中及术后尿量及低钠血症关系 　 作者：王凌雁 张恒 王海军 何东升 【摘要】 【目的】 探讨经蝶鞍区病变切除术术后低钠血症发生情况及术中尿量和术后多尿与低钠血症的关系。【方法】 112 例经蝶窦入路鞍区病变切除术患者，记录术中和术后尿量、手术持续时间及术中补液，术后每隔2 ～ 3 d复查血钠，统计术后低钠的发生率和多尿的发生情况，比较低钠血症组和血钠正常组间术后多尿的发生情况，以及术中尿量、术中补液量和手术持续时间是否存在差别。【结果】 术后低钠血症的发生率为22.3%，其中以迟发性低钠血症为主;低钠血症组和血钠正常组间早期一过性多尿(3 d内)、3天后发生的多尿及持续性多尿(术后3 d内及3 d后均存在多尿)的发生率均不存在差别(P值分别为0.306、0.769和0.335);对于术后出现多尿的患者，术中尿量、补液量和手术持续时间在两组间比较无差别，但是低钠血症组术中尿量和时间的比值高于血钠正常组(P = 0.037)。【结论】 经蝶鞍区病变切除术后低钠血症的发生率较高;术中尿量和时间的比值，较单纯术中尿量和术后多尿更能迅速反应手术操作对垂体-垂体柄-下丘脑的影响，可以作为预测术后低钠血症发生的指标。 【关键词】 低钠血症; 多尿; 经蝶手术 　Abstract： 【Objective】 To assess the incidence of hyponatremia and to investigate the relationship of intraoperative urinary volume and postoperative polyuria with hyponatremia in the patients who had undergone transsphenoidal saddle area surgery. 【Methods】 A total of 112 patients who underwent transsphenoidal saddle area surgery had monitored the urinary volume perioperatively and after surgery， intravenous fluids perioperatively and duration of surgery. Serum sodium was measured every 2 or 3 days. Prevalence of postoperative hyponatremia and polyuria were surveyed， the factors including postoperative polynuria， intraoperative urinary volume， intravenous fluids perioperatively， and surgery duration were compared between the group of hyponatremia and the group of normal serum sodium. 【Result】 22.3% of patients developed postoperative hyponatremia and most of them showed delayed hyponatremia. There were no significant difference between hyponatremia group and normal serum sodium group in the prevalence of early transient polyuria， later transient polyuria and biphasic polynuria (P = 0.306， 0.769， and 0.335， respectively). The urinary volume， intravenous fluids perioperatively and duration of surgery did not correlate with the development of hyponatremia， but the ratio of urinary volume perioperatively and procedure duration was higher in the hyponatremia group (P = 0.037). 【Conclusions】 Postoperative hyponatremia after transs