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目的探讨鞍区肿瘤术后低钠血症的病因、鉴别诊断和治疗方法。方法回顾性分析鞍区肿瘤术后并发低钠血症25例,其中肿瘤全切除14例,次全切除6例,部分切除5例。所有患者术前、手术当日及术后每日监测血、尿钠浓度,血、尿渗透压,尿量,中心静脉压的变化,根据检查结果及临床表现进行分析,并采用相应的治疗方案。结果本组出现低钠血症者占同期鞍区肿瘤手术的21.4%。25例中脑性盐耗综合征(CSWS)15例,抗利尿激素分泌不当综合征(SIADH)10例。24例经积极治疗治愈,1例因并发肺内感染及ARDS死亡。结论鞍区侵犯下丘脑的肿瘤术后易出现低钠血症;CSWS和SIADH临床上易混淆,需认真分析,明确诊断,采用正确的治疗方法。
Objective To study the etiology, differential diagnosis and treatment of postoperative hyponatremia in sellar region. Methods Twenty-five patients with postoperative hyponatremia in the sellar region were retrospectively analyzed. Totally 14 patients underwent total resection, 6 underwent total subtotal resection and 5 underwent partial resection. All patients before operation, daily operation and postoperative daily monitoring of blood, urine sodium concentration, blood, urine osmotic pressure, urine output, central venous pressure changes, according to the examination results and clinical manifestations were analyzed, and the corresponding treatment. Results This group of hyponatremia patients accounted for 21.4% of the same period of sellar tumor surgery. Twenty-five patients had mid-salt syndrome (CSWS), 15 had anti-diuretic hormone syndrome (SIADH), 10 had CSAD. 24 cases were cured by active treatment, 1 case died of complicated pulmonary infection and ARDS. Conclusions The saddle area is prone to hyponatremia after the tumor of the hypothalamus. CSWS and SIADH are confused clinically, so careful analysis, definite diagnosis and proper treatment should be taken.