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

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【中图分类号】 R739.41 【文献标志码】 A 【文章编号】 1672-7770（2025）03-0298-06

Abstract： ObjectiveTo explore the risk factors for hyponatremia after endoscopic endonasal resection of pituitary adenomas.MethodsThe 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 2O19 to December 2O23 were analyzed retrospectively.The clinical factors were compared between patients who developed hyponatremia（hyponatremia group）and those with normal sodium levels on the 7th postoperative day（normal group）. Multivariate Logistic regression was employed to detect the risk factors for hyponatremia on the 7th postoperative day.ResultsOn 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 （ ，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 4th postoperative day were more likely to develop hyponatremia on the 7th postoperative day （AUC =75 ： 4% ）. ConclusionsPostoperative 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.

Key words：pituitary adenoma；neuroendoscope；delayed hyponatremia；risk factor

垂体由腺垂体、神经垂体及垂体间叶组成，垂体腺瘤起源于垂体前叶腺垂体细胞，是鞍区最常见的神经内分泌良性肿瘤，约占所有颅内肿瘤的15%[1] ;除催乳素腺瘤外，手术治疗是各型肿瘤的一线治疗选择[2-4]。（剩余10071字）