术前皮质醇正常的临床型垂体瘤卒中患者使用糖皮质激素治疗的疗效分析

发布时间：2018-05-26 16:36

本文选题：垂体瘤卒中 + 急诊手术　；参考：《西南医科大学》2017年硕士论文

【摘要】：目的:探究术前清晨8:00血清皮质醇水平处于正常范围内的临床型垂体瘤卒中患者使用糖皮质激素治疗的疗效与安全性。方法:回顾性分析从2007年1月至2016年7月入住我院神经外科的符合纳入条件的43例临床型垂体瘤卒中患者的病历资料及影像资料,将其按照入院后是否使用糖皮质激素治疗分成使用糖皮质激素治疗组(观察组)和未使用糖皮质激素治疗组(对照组),43例患者均行手术治疗,观察组术前、术后一周都使用激素治疗,统计分析两组患者临床症状、手术全切率、术后症状改善、术后内分泌改善情况、平均住院时间、术后病理类型、术后第3天、术后第7天的血清皮质醇水平变化情况、低钠血症及尿崩的发生情况,进而分析急诊手术效果,糖皮质激素治疗的疗效。结果:(1)43例患者中突发头昏头痛37例,占86.05%;视物模糊29例,占67.44%;恶心、呕吐23例,占53.49%;有急性失明5例,占11.62%;泌乳、闭经3例,占6.97%;肢端肥大2例,占4.65%;3例患者查体颈项强直,克氏征阳性,脑膜刺激征表现,占6.97%;发生偏瘫2例,占4.65%。(2)急诊手术治疗,其中行经鼻蝶窦显微镜下切除术患者39例,行开颅切除术患者4例,术后肿瘤全切41例,全切率为95.35%,次全切患者2例,次全切率为4.65%。其中观察组18例患者,全切17例,次全切1例,对照组25例患者,全切24例,次全切1例,p0.05,差异无统计学意义。(3)术后患者头昏头痛症状较术前明显缓解33例,其中观察组16例,对照组17例,未见明显改善观察组1例,对照组2例,观察组中1例患者加重,p0.05,差异无统计学意义;两组患者视力模糊、恶心、呕吐均有所缓解;5例急性失明患者中有3例完全缓解,2例明显改善。(4)术后内分泌症状改善情况,垂体泌乳素观察组正常16例,低于正常2例,对照组正常18例,低于正常7例,p0.05,差异无统计学意义;生长激素观察组正常14例,低于正常4例,对照组正常19例,低于正常6例,p0.05,差异无统计学意义;ft3、ft4观察组正常16例,降低2例,对照组正常14例,降低11例,p0.05,差异无统计学意义。(5)术后平均住院时间,观察组(13.21±5.78)天,对照组(13.71±4.93)天,p0.05,差异无统计学意义。(6)术后病理报告示无功能性腺瘤19例,促性腺激素腺瘤11例,垂体泌乳素(prl)腺瘤5例,生长激素腺瘤(gh)3例,混合腺瘤3例,acth型腺瘤1例,tsh腺瘤1例。(7)术后血清皮质醇水平变化情况,两组患者在术后第三天清晨8:00血清皮质醇水平分别为(13.89±6.53)ug/dl、(9.46±3.66)ug/dl,p0.05,差异有统计学意义;两组患者在术后第七天清晨8:00血清皮质醇水平分别为(13.19±4.64)ug/dl、(8.78±2.20)ug/dl,p0.05,差异有统计学意义。(8)术后皮质醇低于4ug/dl,观察组0人,对照组3人,p0.05,差异无统计学意义。(9)术后发生一过性尿崩观察组3人,对照组6人,p0.05,差异无统计学意义。(10)术后发生低钠血症(低于135mmol/l)观察组3人,对照5人,p0.05,差异无统计学意义。(11)术后一月两组患者皮质醇水平分别为(9.01±4.51)ug/dl、(8.93±4.27)ug/dl,p0.05,差异无统计学意义;术后三月皮质醇分别为(9.34±3.87)ug/dl、(8.72±4.09)ug/dl,p0.05,差异无统计学意义。(12)术后3例皮质醇低于4ug/dl患者中有2例患者皮质醇逐渐恢复,不需长期替代治疗,仅有1例患者长期口服激素替代治疗。结论:1.糖皮质激素替代治疗仅有利于维持患者血清皮质醇水平,但对患者术后恢复及术后并发症的预防无明显作用。因此术前皮质醇水平在正常范围内的临床型垂体瘤卒中患者可在严密监测血清皮质醇水平的情况下不使用糖皮质激素替代治疗,但由于本研究纳入病例数少,临床个体差异,术前皮质醇在正常范围内的临床垂体瘤卒中患者是否需使用糖皮质激素治疗仍有待进一步研究。2.手术切除术后,患者残留垂体腺功能有一定恢复,可不使用激素替代治疗,功能未得到恢复患者可在密切监测垂体功能前提下使用激素替代治疗。3.临床型垂体瘤卒中患者入院后积极完善相关术前检查,急诊行手术治疗对患者的临床症状、体征均有明显的改善,经鼻蝶鞍区占位切除术手术全切率高、术后并发症少、对患者损伤较小,是目前垂体瘤卒中的首选手术治疗方式。4.垂体瘤卒中发病率的高低,无功能性腺瘤促性腺激素腺瘤垂体泌乳素(PRL)腺瘤生长激素腺瘤(GH)混合腺瘤ACTH型腺瘤、TSH腺瘤。
[Abstract]:Objective: To explore the efficacy and safety of glucocorticoid therapy for clinical pituitary tumor stroke patients at 8:00 before 8:00 in the morning. Methods: a retrospective analysis of the medical records of 43 patients with clinical pituitary apoplexy from January 2007 to July 2016. The material and image data were divided into the treatment group (observation group) and the unused glucocorticoid treatment group (control group) in the treatment group (observation group) and unused glucocorticoid treatment group (control group) in accordance with the use of glucocorticoid after admission. 43 patients were treated with surgical treatment. The observation group was treated with irritable treatment in the first week of the operation. The clinical symptoms of the two groups were analyzed and the operation was completely cut. Rate, postoperative symptoms improvement, postoperative endocrine improvement, average hospitalization time, postoperative pathological type, third days after operation, changes in serum cortisol level, hyponatremia and diabetes insipidus at seventh days after operation, and then analyzed the effect of emergency operation and glucocorticoid treatment. Results: (1) 37 cases of sudden dizziness and headache in 43 patients. Accounting for 86.05%, 29 cases, 67.44%, 23 cases of nausea and vomiting, 53.49%, 5 cases of acute blindness, 11.62%, lactation, amenorrhea 3, 6.97%, 2 acromegaly, 4.65%, and 3 cases of neck rigidity, Kirschner's sign, meningeal irritation, accounting for 6.97%; 4.65%. emergency surgery, which took the transnasal butterfly Dou Xian There were 39 cases of microendoscopic resection, 4 cases of craniotomy, 41 cases of total resection of tumor after operation, total resection rate of 95.35%, and 2 cases of subtotal resection. The subtotal resection rate was 4.65%. in the observation group of 18 cases, total resection in 17 cases, subtotal resection in 1 cases, and 25 patients in the control group, 24 cases of total resection, total resection of 1 cases, and the difference was not statistically significant. (3) postoperative head FATP. The pain symptoms were significantly relieved in 33 cases, including 16 in the observation group and 17 in the control group, with no obvious improvement in the observation group, 1 in the observation group, 2 in the control group and 1 in the observation group, P0.05, with no statistically significant difference; the two groups were relieved of blurred vision, nausea and vomiting in the two group; 3 patients in 5 cases were completely relieved and 2 cases improved significantly (4). After the improvement of endocrine symptoms, 16 cases in the pituitary prolactin observation group were normal, 2 cases were lower than normal and 18 cases in the control group, 18 cases were normal, 7 cases were lower than normal, P0.05, the difference was not statistically significant; the growth hormone observation group was normal 14 cases, lower than normal 4 cases, normal 19 cases in the control group, lower than the normal 6 cases, and the difference was not statistically significant; FT3, FT4 observation group was normal 16 For example, 2 cases were reduced and 14 cases in the control group were normal, 11 cases decreased, P0.05, the difference was not statistically significant. (5) the average hospitalization time after operation, the observation group (13.21 + 5.78) days, the control group (13.71 + 4.93) days, the difference was not statistically significant. (6) 19 cases of reactive power adenomas, 11 cases of gonadotropin adenoma and 5 cases of pituitary prolactin (PRL) adenoma after operation were reported. 3 cases of long hormone adenoma (GH), 3 cases of mixed adenoma, 1 cases of ACTH type adenoma, 1 cases of TSH adenoma. (7) the change of serum cortisol level after operation. The serum cortisol level was (13.89 + 6.53) ug/dl (9.46 + 3.66) ug/dl, P0.05, respectively, at 8:00 postoperatively at the early morning after the operation, and the difference was statistically significant; the patients in the two group were at 8:00 in the morning after the operation. The level of cortisol was (13.19 + 4.64) ug/dl, (8.78 + 2.20) ug/dl, P0.05, and the difference was statistically significant. (8) the cortisol was lower than 4ug/dl, 0 in the observation group, 3 in the control group, and P0.05, with no statistical significance. (9) there was 3 in the observation group of diabetes insipidus, 6 in the control group and P0.05 in the control group. (10) there was low sodium blood after operation. There were 3 people in the observation group (lower than 135mmol/l), 5 people and P0.05, the difference was not statistically significant. (11) the level of cortisol was (9.01 + 4.51) ug/dl, (8.93 + 4.27) ug/dl, P0.05, respectively, and the cortisol was (9.34 + 3.87) ug/dl, (8.72 + 4.09) ug/dl, P0.05, P0.05, no statistical significance after the operation. After 3 cases of cortisol lower than 4ug/dl, 2 patients with cortisol gradually recovered, without long-term replacement therapy, only 1 patients had long-term oral hormone replacement therapy. Conclusion: 1. glucocorticoid replacement therapy is only beneficial to maintain the patient's serum cortisol level, but it has no obvious effect on postoperative recovery and postoperative complications. Clinical pituitary apoplexy patients with normal cortisol levels can not use corticosteroid replacement therapy if the serum cortisol level is closely monitored. However, due to the small number of cases in this study and the difference in the clinical individual, whether the patients with pituitary tumor stroke need to use sugar before the operation of cortisol in the normal range. Corticosteroid therapy still needs further study of.2. resection. The residual pituitary gland function of the patients is restored, and hormone replacement therapy is not used. The patients who have not recovered function can use hormone replacement therapy under the premise of close monitoring of pituitary function to treat.3. clinical pituitary tumor stroke patients after admission. The clinical symptoms and signs of the patients were obviously improved, the total resection rate was high, the postoperative complications were less and the patients were less injured. It was the first choice of surgical treatment for pituitary tumor stroke, the incidence of.4. pituitary apoplexy, no functional adenomatous adenomatous adenomatous adenomatous adenoma. Prolactin (PRL) adenoma growth hormone adenoma (GH) mixed adenoma type ACTH adenoma, TSH adenoma.
【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R736.4

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