鞍区肿瘤术后、重度颅脑损伤合并中枢性尿崩症的早期临床诊断意义及预后分析

Analysis on early diagnosis and prognosis of central diabetes insipidus caused by sellar tumor surgery or severe traumatic brain injury

摘要:

目的 探讨鞍区肿瘤术后、重度颅脑损伤合并中枢性尿崩症的早期临床诊断意义及预后分析。方法 选取在我院就诊的48例鞍区肿瘤术后或重度颅脑损伤合并中枢性尿崩症患者,按照诊断类型分为短暂性尿崩症组(A组),持续性尿崩症组(B组),三相性尿崩症组(C组),检测患者治疗前后实验室指标,同时分析患者预后情况。结果 ①治疗结束后,A组、C组在血钠、血渗透压、24尿钠及24h尿量均降低,同治疗时比较,差异具有显著性意义(P<0.05或P<0.01);治疗后A组、C组血渗透压,24h尿钠均低于B、C组(P<0.05);②治疗后经GOS评分,B组、C组4分及以下患者所占比例明显高于A组(P<0.05),而5分者均低于A组(P<0.05);③患者随访1年,A组患者生存状况良好,与B组死亡3例、C组死亡3例相比较,差异有统计学差异(P<0.05);④B、C组ADH术后先下降后上升,但未能达到正常水平,A组先升高后下降,后恢复至正常水平。结论 鞍区肿瘤术后、重度颅脑损伤合并CDI患者的预后与血ADH水平、24小时尿量有一定的相关性,不同类型CDI预后生存状况存在一定差异。

Abstract:

Objective To investigate the significance of early diagnosis and prognosis of central diabetes insipidus(CDI) caused by sellar tumor surgery or severe traumatic brain injury.Methods Forty-eight cases patients of CDI caused by sellar tumor surgery or severe traumatic brain injury hospitalized in our hospital were selected. These patients were divided into 3 groups. Group A:transient diabetes insipidus. Group B: persistent diabetes insipidus. Group C: triphasic diabetes insipidus. Laboratory markers were measured before and after treatment, and prognostic analysis was performed.Results Serum sodium and osmolality, 24 urinary sodium level and 24h urine volume of group A and C, decreased after treatment, the statistical differences were significant (P<0.05 or P<0.01). Serum osmolality, 24h urinary sodium of group A and C decreased than group B (P<0.05). In the aspect of GOS score after treatment, the ratio of patients scored 4 points or below in group B and group C was significantly higher than group A (P<0.05). The ratio of patients scored 5 points in group B and group C was significantly lower than in group A. All patients were followed up for one year, and the patients in group A had a significantly better survival than those in group B and group C (three cases died in each group) (P<0.05). In group B and group C, the postoperative level of antidiuretic hormone (ADH) initially decreased and then increased, but did not reach the normal level; in group A, the level of ADH increased initially andthen decreased, and finally reached the normal level.Objective The prognosis of patients with CDI after sellar tumor surgery or associated with severe traumatic brain injury is related to serum ADH level, and 24h urine volume.There are some differences in prognosis and survival between different types of CDI.