摘要
目的探讨儿童颅咽管瘤术后基于快速康复外科(ERAS)理念水电解质管理的临床疗效。方法回顾性分析2018年1月至2020年3月空军军医大学西京医院神经外科采用手术治疗的80例颅咽管瘤患儿的临床资料。术后37例参照2017版《颅咽管瘤围手术期管理中国专家共识》进行治疗(A组),43例依据在ERAS理念指导下拟定的水电解质管理方案治疗(B组),比较两组患者的临床资料、血清Na+含量与每24 h波动幅度、尿崩控制情况及其疗效。结果两组患者的年龄、性别、体重指数、肿瘤最大径、肿瘤质地、QST分型、手术入路、肿瘤切除程度及病理学类型间的差异均无统计学意义(均P>0.05)。术后1周,B组血清Na+出现高危(<130 mmol/L和>150 mmol/L)的次数少于A组[中位数(四分位数间距)分别为:53(20.3)对比84(33.5)、67(25.6)对比90(35.8),均P<0.05],而出现低危(130~150 mmol/L)的次数多于A组[141(54.1)对比77(30.7),P<0.05]。术后1~7 d,A组的血清Na+每24 h波动幅度均高于B组(均P<0.05);两组均随术后时间的增加,血清Na+每24 h波动幅度逐渐减小(F1=105.200、F2=87.100 ,均P<0.05)。术后1 d,两组日平均尿量的差异无统计学意义(P>0.05),而术后2~7 d,A组的日平均尿量均高于B组(均P<0.05);两组均随术后时间的增加,日平均尿量逐渐减少(F1=62.600、F2=99.400,均P<0.05)。出院时B组的格拉斯哥昏迷评分高于A组[分别为(14.5±3.6)分、(10.3±4.9)分,P<0.05],且住院时间短于A组[分别为(9.7±2.9)d、(14.9±4.8)d,P<0.05],但是两组Karnofsky功能状态和医院焦虑抑郁量表评分的差异均无统计学意义(均P>0.05)。结论儿童颅咽管瘤术后基于ERAS理念的水电解质管理具有稳定血清Na+含量、降低Na+波动幅度、控制尿崩及在一定程度上改善临床疗效的作用。
Objective To investigate therapeutic effects of postoperative fluid and electrolyte management based on enhanced recovery after surgery(ERAS)in craniopharyngioma patients.Methods A total of 80 patients with craniopharyngiomas undergoing surgical operation at Department of Neurosurgery,Xijing Hospital,Air Force Military Medical University from January 2018 to March 2020 were retrospectively enrolled in this study.Among them,37 patients in group A received normal fluid and electrolyte strategies,while 43 patients in group B were treated with ERAS based managements post operation.The clinical features,serum Na+level and fluctuations,diabetes insipidus control quality,and therapeutic effect in the two groups were evaluated after surgery.Results There was no statistical difference in age,gender,body mass index,tumor maximal diameter,tumor texture,QST type,surgical approach,extent of tumor resection,or pathological type between group A and group B(all P>0.05).In the first week after surgery,the serum Na+values in group B appeared less frequently at high-risk levels(<130 mmol/L and>150 mmol/L)than those in group A[median(interquartile range):53(20.3)vs.84(3.5),67(25.6)vs.90(35.8),both P<0.05],while they were more often at low-risk level(130-150 mmol/L)in group B than in group A[141(54.1)vs.77(30.7),P<0.05].From day 1 to day 7 post surgery,daily fluctuation ranges of serum Na+in group B were lower compared with those in group A(all P<0.05),and the fluctuation ranges in both groups were gradually reduced with the increase of postoperative time(F1=105.200,F2=87.100,both P<0.05).The difference in the average urine output between group A and B had no statistical significance at day 1 post surgery(P>0.05).However,daily urine output in group A was higher than that in group B from day 2 to day 7 post surgery(all P<0.05).Furthermore,the average daily urine output in both groups presented a trend of decrease from day 2 to day 7 post surgery(F1=62.600,F2=99.400,both P<0.05).Glasgow coma scale(14.5±3.6 points vs.10.3±4.9 points)a
作者
叶玉勤
琚玲丽
杨永祥
苏鑫洪
孔垂广
王冠一
贾怡斌
贺晓生
Ye Yuqin;Ju Lingli;Yang Yongxiang;Su Xinhong;Kong Chuiguang;Wang Guanyi;Jia Yibin;He Xiaosheng(Department of Neurosurgery,Xijing Hospital,Air Force Military Medical University,Xi′an 710032,China;Department of Neurosurery,the PLA 921th Hospital,Changsha 410000,China)
出处
《中华神经外科杂志》
CSCD
北大核心
2020年第9期903-907,共5页
Chinese Journal of Neurosurgery
基金
国家自然科学基金(81471264,81971156)。
关键词
颅咽管瘤
儿童
快速康复外科
电解质
尿崩症
Craniopharyngioma
Child
Enhanced recovery after surgery
Electrolytes
Diabetes insipidus
