Zada Gabriel, Liu Charles Y, Fishback Dawn, Singer Peter A, Weiss Martin H
Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California 90089, USA.
J Neurosurg. 2007 Jan;106(1):66-71. doi: 10.3171/jns.2007.106.1.66.
The goal of this study was to assess the incidence of symptomatic and occult hyponatremia in patients who had undergone transsphenoidal pituitary surgery.
Patients who underwent transsphenoidal surgery at the University of Southern California University Hospital between 1997 and 2004 had serum sodium levels drawn on an outpatient basis on postoperative Day 7. Patient records were retrospectively reviewed to determine the incidence of, and risk factors for, symptomatic and asymptomatic hyponatremia. Two hundred forty-one patients had routine serum sodium levels drawn as outpatients on postoperative Day 7. Twenty-three percent of these patients were found to be hyponatremic (Na < or =135 mEq/L). The overall incidence rate of symptomatic hyponatremia in the 241 patients was 5%. The majority of hyponatremic patients (80%) remained asymptomatic, whereas 20% became symptomatic. In patients with symptomatic hyponatremia, the mean sodium level at diagnosis was 120.5 mEq/L, compared with 128.4 mEq/L in asymptomatic, hyponatremic patients (p < 0.0001). Female patients were more likely to develop hyponatremia than male patients (33% compared with 22%, p < 0.03). Fifty-two percent of patients who had transient diabetes insipidus (DI) early in their postoperative course subsequently developed hyponatremia, compared with 21% of those who did not have DI (p < 0.001). Patient age, tumor type, and tumor size did not correlate with development of delayed hyponatremia. Outpatients with moderately and severely low sodium levels were 5 and 12.5 times more likely, respectively, to be symptomatic than were patients with mild hyponatremia.
Delayed hyponatremia occurs more frequently than was previously suspected in patients who have undergone transsphenoidal surgery, especially in female patients and those who have previously had transient DI. The majority of hyponatremic patients remain asymptomatic. Obtaining a serum sodium value on an outpatient basis 1 week after pituitary surgery is helpful in recognition, risk stratification, and subsequent intervention, and may prevent potentially serious complications.
本研究的目的是评估经蝶窦垂体手术患者中症状性和隐匿性低钠血症的发生率。
1997年至2004年间在南加州大学医院接受经蝶窦手术的患者在术后第7天门诊抽取血清钠水平。回顾患者病历以确定症状性和无症状性低钠血症的发生率及危险因素。241例患者在术后第7天门诊常规抽取血清钠水平。其中23%的患者被发现有低钠血症（Na≤135 mEq/L）。241例患者中症状性低钠血症的总体发生率为5%。大多数低钠血症患者（80%）无症状，而20%出现症状。症状性低钠血症患者诊断时的平均钠水平为120.5 mEq/L，无症状性低钠血症患者为128.4 mEq/L（p<0.0001）。女性患者比男性患者更易发生低钠血症（分别为33%和22%，p<0.03）。术后早期出现短暂性尿崩症（DI）的患者中有52%随后发生低钠血症，未发生DI的患者中这一比例为21%（p<0.001）。患者年龄、肿瘤类型和肿瘤大小与迟发性低钠血症的发生无关。门诊中、重度低钠水平的患者出现症状的可能性分别是轻度低钠血症患者的5倍和12.5倍。
经蝶窦手术患者中迟发性低钠血症的发生比以前怀疑的更频繁，尤其是女性患者和既往有短暂性DI的患者。大多数低钠血症患者无症状。垂体手术后1周门诊测定血清钠值有助于识别、风险分层及后续干预，并可预防潜在的严重并发症。
