神經(jīng)內(nèi)鏡經(jīng)鼻垂體腺瘤術(shù)后遲發(fā)性低鈉血癥的危險(xiǎn)因素分析

【中圖分類號(hào)】 R739.41 【文獻(xiàn)標(biāo)志碼】 A 【文章編號(hào)】 1672-7770（2025）03-0298-06

Abstract： ObjectiveTo explore the risk factors for hyponatremia after endoscopic endonasal resection of pituitary adenomas.MethodsThe clinical data of 361 pituitary adenoma patients treated by a same surgical team in the Department of Neurosurgery， Xinqiao Hospital，Army Medical University from January 2O19 to December 2O23 were analyzed retrospectively.The clinical factors were compared between patients who developed hyponatremia（hyponatremia group）and those with normal sodium levels on the 7th postoperative day（normal group）. Multivariate Logistic regression was employed to detect the risk factors for hyponatremia on the 7th postoperative day.ResultsOn the 7th postoperative day，the incidence of hyponatremia was 24.1% （（87/361）. Compared with the normal group，the hyponatremia group had larger tumor volumes（ P=0.042 ），intraoperative blood loss was greater，surgery timesand was longer，and the proportion of cerebrospinal fluid leakage during surgery was higher（ Plt;0.001 ）.Serum sodium levels on the 4th postoperative day and FT3 levels on the 7th postoperative day were lower（ Plt;0.001） .The incidence of intracranial infection was higher（ Plt;0.001? ）and the proportion of analgesic drug use was also higher（ P=0.004 ）. Multivariate Logistic regression analysis identified low blood serum sodium on the 4th postoperative day （OR=0.85，Plt;0.001） ，postoperative intracranial infection （ ，and use of analgesic medications postoperatively（ OR=2.38，P=0.016） as independent risk factors for hyponatremia on the 7th postoperative day. Patients with blood sodium levels below 139.6 mmol/L on the 4th postoperative day were more likely to develop hyponatremia on the 7th postoperative day （AUC =75 ： 4% ）. ConclusionsPostoperative intracranial infection and use of analgesic medications may be closely associated with the development of delayed hyponatremia. Therefore，it is essential to closely monitor patients at high risk for intracranial infections and those requiring postoperative analgesics，with an emphasis on early detection and timely intervention. Monitoring blood sodium levels on the 4th postoperative day and early intervention may help reduce the incidence of delayed hyponatremia.

Key words：pituitary adenoma；neuroendoscope；delayed hyponatremia；risk factor

垂體由腺垂體、神經(jīng)垂體及垂體間葉組成，垂體腺瘤起源于垂體前葉腺垂體細(xì)胞，是鞍區(qū)最常見的神經(jīng)內(nèi)分泌良性腫瘤，約占所有顱內(nèi)腫瘤的15%^[1] ;除催乳素腺瘤外，手術(shù)治療是各型腫瘤的一線治療選擇[2-4]。隨著高清神經(jīng)內(nèi)鏡的應(yīng)用，完全神經(jīng)內(nèi)鏡下經(jīng)鼻入路已成為垂體腺瘤的主要手術(shù)方式[5]，且隨著技術(shù)的進(jìn)步，神經(jīng)內(nèi)鏡下經(jīng)鼻入路手術(shù)不僅提高了腫瘤全切除率，還降低了手術(shù)總體并發(fā)癥的發(fā)生率[]，但術(shù)后遲發(fā)性低鈉血癥依然是常見的并發(fā)癥之一，成為經(jīng)鼻垂體腺瘤患者術(shù)后再入院的主要原因[7-8]，對(duì)患者的預(yù)后及住院時(shí)間有顯著影響，應(yīng)引起臨床足夠的重視。遲發(fā)性低鈉血癥是指術(shù)后3d之后發(fā)生的低鈉血癥，最常發(fā)生在術(shù)后第7天左右[5.9-10]，血鈉水平也通常在術(shù)后第7天左右達(dá)到最低[8]。本研究納人2019 年1月—2023年12月陸軍軍醫(yī)大學(xué)第二附屬醫(yī)院神經(jīng)外科同一醫(yī)療組收治的361例垂體腺瘤患者，旨在分析神經(jīng)內(nèi)鏡經(jīng)鼻垂體腺瘤術(shù)后第7天發(fā)生低鈉血癥的危險(xiǎn)因素，為臨床提供參考。現(xiàn)報(bào)告如下。

1資料與方法

1.1一般資料共納入361例垂體腺瘤患者，根據(jù)術(shù)后第7天是否發(fā)生低鈉血癥，分為低鈉組87例，正常組274例。低鈉組中，男35例，女52例；平均年齡 （48.5±12.8） 歲。正常組中，男122例，女152例；平均年齡（ （48.3±13.1） 歲。術(shù)前資料包括患者性別、年齡、腫瘤體積、術(shù)前激素水平、腫瘤內(nèi)分泌功能等；術(shù)中資料包括手術(shù)時(shí)長、血液丟失量、術(shù)中腦脊液漏等情況；術(shù)后資料包括術(shù)后激素水平、電解質(zhì)、尿量，是否尿崩、顱內(nèi)感染發(fā)生情況、術(shù)后激素替代、鎮(zhèn)痛處理。……