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[神经外科肿瘤疾病术后低钠血症]

[Hyponatremia in the postoperative period after a neurosurgical tumor condition].

作者信息

Carrascosa A J, Salcedo E, Gallego M E, Bermúdez J L, Yuste J A, Lledó G

机构信息

Servicio de Anestesiología y Reanimación, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid.

出版信息

Rev Esp Anestesiol Reanim. 1999 Jan;46(1):40-4.

Abstract

A four-year-old girl suffered difficult-to-diagnose hyponatremia resistant to treatment following surgery for a suprasellar tumor. The final diagnosis was diabetes insipidus evolving in three stages. Hyponatremia is a common problem following surgery to remove brain tumors. Early diagnosis and treatment of this electrolytic imbalance are essential for preventing serious neurological symptoms or death. The conditions most closely related to hyponatremia are inappropriate antidiuretic hormone secretion syndrome (IADHSS) and cerebral salt wasting syndrome (CSWS). The latter has become more common in recent years among patients undergoing brain surgery. Whereas IADHSS is treated by restricting fluids, CSWS requires administration of salt and volume fluid volume. We believe that for differential diagnosis of postoperative hyponatremia, a fluid restriction test takes priority over of fluid loading following neurosurgery. The course of hyponatremia must be carefully monitored and a complete endocrinological workup must be performed to detect the possible presence of hypophyseal deficiencies, particularly hypothyroidism and suprarenal insufficiency.

摘要

一名四岁女童在接受鞍上肿瘤手术后出现难以诊断且治疗抵抗的低钠血症。最终诊断为尿崩症,其发展经历三个阶段。低钠血症是脑肿瘤切除术后的常见问题。早期诊断和治疗这种电解质失衡对于预防严重的神经症状或死亡至关重要。与低钠血症关系最为密切的病症是抗利尿激素分泌不当综合征(IADHSS)和脑性盐耗综合征(CSWS)。近年来,后者在接受脑部手术的患者中更为常见。IADHSS通过限制液体摄入来治疗,而CSWS则需要补充盐分和液体容量。我们认为,对于术后低钠血症的鉴别诊断,在神经外科手术后,限水试验优先于补液试验。必须仔细监测低钠血症的病程,并且必须进行全面的内分泌检查以检测可能存在的垂体功能减退,特别是甲状腺功能减退和肾上腺功能不全。

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