临床神经外科杂志2025，Vol.22Issue(3)：298-303,6.DOI:10.3969/j.issn.1672-7770.2025.03.010
神经内镜经鼻垂体腺瘤术后迟发性低钠血症的危险因素分析
Risk factors of delayed hyponatremia after endoscopic endonasal pituitary adenoma surgery
摘要
Abstract
Objective To explore the risk factors for hyponatremia after endoscopic endonasal resection of pituitary adenomas.Methods The 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 2019 to December 2023 were analyzed retrospectively.The clinical factors were compared between patients who developed hyponatremia(hyponatremia group)and those with normal sodium levels on the 7 th postoperative day(normal group).Multivariate Logistic regression was employed to detect the risk factors for hyponatremia on the 7 th postoperative day.Results On 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(P＜0.001).Serum sodium levels on the 4th postoperative day and FT3 levels on the 7th postoperative day were lower(P＜0.001).The incidence of intracranial infection was higher(P＜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,P＜0.001),postoperative intracranial infection(OR=17.88,P=0.009),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 4 th postoperative day were more likely to develop hyponatremia on the 7 th postoperative day(AUC=75.4％).Conclusions Postoperative 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.关键词
垂体腺瘤/神经内镜/迟发性低钠血症/危险因素Key words
pituitary adenoma/neuroendoscope/delayed hyponatremia/risk factor分类
医药卫生引用本文复制引用
何文武,张源,李松,杨辉,张晓青..神经内镜经鼻垂体腺瘤术后迟发性低钠血症的危险因素分析[J].临床神经外科杂志,2025,22(3):298-303,6.基金项目
重庆市自然科学基金面上项目(CSTB2024NSCQ-MSX0021) （CSTB2024NSCQ-MSX0021）
