下垂体瘤手术后延迟低血的预测因素
Remya Rajan1, Ari George Chacko2, Shivendra Verma3
1Endocrinology, Christian Medical College and Hospital Vellore, Vellore, India.
Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et metabolisme
|June 9, 2023
概括
下垂体手术后延迟的低血是常见的. 术后早期的无味糖尿病,脑脊髓液泄漏和类固醇使用预测了这种并发症,需要在术后7-10天左右进行监测.
科学领域:
- 神经外科 神经外科
- 内分泌学 在内分泌学.
- 在瘤学瘤学.
背景情况:
- 延迟性低血症 (DH) 是对下垂体瘤进行跨形手术 (TSS) 后的常见并发症.
- 了解DH预测因子对于患者管理和预防不良结果至关重要.
研究的目的:
- 为了确定TSS之后的DH的流行率.
- 确定与DH相关的临床和手术前的因素,包括早期手术后的无味糖尿病 (EPDI).
主要方法:
- 在26个月内对98名患者进行的100次TSS手术的回顾性分析.
- 患者特征和手术前参数在患有和没有肝炎的组之间的比较 (手术后4-14天).
- 后勤回归分析以确定DH的显著预测因素.
主要成果:
- 36%的患者患有DH,主要在术后7-8天被诊断出来;22%的患者有症状.
- 不适当的抗尿激素分泌综合征 (SIADH) 是最常见的DH的原因.
- 在手术期间的脑脊髓液 (CSF) 泄漏 (OR 5.0),EPDI (OR 3.4) 和外科期间的类固醇使用 (OR 3.6) 是DH的显著预测因素.
结论:
- 在TSS之后,EPDI,手术内CSF泄漏和术前类固醇使用是DH的显著预测因素.
- 对于中度至重度的低血,EPDI的特异性为80%,但敏感度低 (47%).
- 建议在术后7-10天对高风险患者进行血清度监测,以检测无症状的DH.
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