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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 46例鞍区肿瘤术后、重度颅脑损伤合并中枢性尿崩症患者,根据诊断类型的不同分为A组和B组,各23例。A组为持续性尿崩症患者,B组为短暂性尿崩症患者。比较两组患者治疗前后各项实验室指标变化以及预后情况。结果与治疗前比较,B组患者血渗透压、血钠、24 h尿量均明显降低(P<0.05),A组治疗后各指标与治疗前比较差异无统计学意义(P>0.05);治疗后B组患者血渗透压、血钠、24 h尿量明显低于A组(P<0.05)。治疗后A组患者格拉斯哥评分(GCS评分)4分以下患者例数显著高于B组,而5分以上患者例数显著低于B组(P<0.05)。A组患者术后抗利尿激素含量先降低后升高,但未恢复至正常水平,而B组患者抗利尿激素先增加后降低,并恢复至正常水平。对患者进行6个月的随访,发现B组患者生存情况良好,而A组患者中2例死亡。结论鞍区肿瘤术后、重度颅脑损伤合并中枢性尿崩症患者其预后情况与血液中抗利尿激素含量以及24 h尿量有关,不同类型的中枢性尿崩症患者其预后生存质量具有一定程度的差异。
Objective To investigate the early clinical significance and prognosis of postoperative and severe craniocerebral injury with central diabetes insipidus in sellar region. Methods 46 cases of sellar tumors after surgery, severe craniocerebral injury with central diabetes insipidus patients, according to the type of diagnosis is divided into group A and group B, 23 cases each. Group A patients with persistent diabetes insipidus, Group B patients with transient diabetes insipidus. The changes of laboratory indexes and prognosis of the two groups before and after treatment were compared. Results Compared with those before treatment, the blood osmotic pressure, serum sodium and 24 h urinary volume in group B were significantly lower than those before treatment (P <0.05). There was no significant difference in each index between group A and group before treatment (P> 0.05). After treatment, the blood osmotic pressure, serum sodium and urinary output of 24 h in group B were significantly lower than those in group A (P <0.05). After treatment, the number of cases with Glasgow score (GCS score) less than 4 points in group A was significantly higher than that in group B, while the number of patients with more than 5 points was significantly lower than group B (P <0.05). In group A, the content of antidiuretic hormone decreased first and then increased, but did not return to normal level. In group B, the antidiuretic hormone firstly increased, then decreased, and returned to normal level. Patients were followed up for 6 months and found that patients in group B survived well, while 2 patients in group A died. Conclusion The prognosis of postoperative patients with severe craniocerebral injury complicated with central diabetes insipidus is related to the level of antidiuretic hormone and 24 h urinary volume in patients with sellar tumor. The prognostic quality of life of patients with different types of central diabetes insipidus has certain Difference in degree.