Boehnert M, Hensen J, Henig A, Fahlbusch R, Gross P, Buchfelder M
Department of Neurosurgery, University of Erlangen-Nuremberg, Erlangen, Germany.
Kidney Int Suppl. 1998 Feb;64:S12-4.
Severe hyponatremia has been described after elective surgery with subsequent permanent brain damage. Other authors, however, have noted that morbidity and mortality rates of severe hyponatremia have been greatly overestimated. We retrospectively examined 19 patients (8 male, 11 female) who developed severe hyponatremia (100 to 124 mmol/liter) after transsphenoidal surgery for pituitary adenomas. Eight patients had hormonally inactive adenomas, 5 ACTH-secreting adenomas, 2 GH-secreting adenomas and 4 prolactin-secreting adenomas. The mean age of the patients was 47.5 years, with a range from 16 to 71 years. The mean preoperative serum sodium level was 137.8 mmol/liter. The timing of hyponatremia showed two different patterns. Five patients developed early postoperative hyponatremia (mean 114.0 mmol/liter +/- 4.85) and 14 patients showed the lowest mean serum level one week after surgery (118.1 mmol/liter +/- 6.86). Patients with early hyponatremia had fewer and less severe symptoms than patients with delayed hyponatremia. None of the patients developed seizures or a demyelination syndrome. Despite severe degree of hyponatremia for most of our patients treatment with water restriction and oral sodium supplementation was sufficient.
择期手术后出现严重低钠血症并伴有永久性脑损伤的情况已有相关报道。然而，其他作者指出，严重低钠血症的发病率和死亡率被大大高估了。我们回顾性研究了19例垂体腺瘤经蝶窦手术后发生严重低钠血症（100至124 mmol/升）的患者（8例男性，11例女性）。8例患者为无功能性腺瘤，5例为促肾上腺皮质激素分泌腺瘤，2例为生长激素分泌腺瘤，4例为泌乳素分泌腺瘤。患者的平均年龄为47.5岁，范围为16至71岁。术前血清钠平均水平为137.8 mmol/升。低钠血症的发生时间呈现两种不同模式。5例患者术后早期出现低钠血症（平均114.0 mmol/升±4.85），14例患者在术后一周血清水平降至最低（118.1 mmol/升±6.86）。早期低钠血症患者的症状比延迟性低钠血症患者更少且更轻。所有患者均未发生癫痫发作或脱髓鞘综合征。尽管我们大多数患者的低钠血症程度严重，但限水和口服补充钠盐治疗就足够了。
