论文部分内容阅读
1 临床资料 患者,男,49岁。因头痛一年,视力下降三月余,CT及MRI检查提示“鞍区占位性病变”收入本院。检查:一般情况好,思维及情感正常。左眼视力0.2,右眼视力0.6,双颞侧视野缺损。血电解质及血糖均正常,内分泌学检查未见异常。经左侧翼点入路行肿瘤全切除术,术中见肿瘤大小约3.0cm×3.0cm×40cm,肿瘤累及视交叉前、左侧颈内动脉外侧,并向鞍背后方发展,予以分块全切除。术后病理报告为“颅咽管瘤”。 术后6h,患者出现心慌、胸闷、烦躁不安,检查:血压20/14KPa,脉搏180次/分,给予镇静、降血压及强心等处理,血K~+、Na~+、Cl~-分别为4.15、158.3、123mmol/L,CO_2结合率21mmol/L,此后血Na~+呈进行性上升,术后3d最高达190.9mmol/L,血渗透压最高达347mmol/L,CO_2结合率最低为
1 clinical data patients, male, 49 years old. Due to a headache for one year, visual acuity decreased more than three months, CT and MRI examination prompted “saddle-space-occupying lesions” income in our hospital. Check: The general situation is good, thinking and feeling normal. Left eye vision 0.2, right eye vision 0.6, double temporal defect. Blood electrolytes and blood glucose were normal, no abnormal endocrine examination. The left wing point point line tumor resection, see the tumor size of about 3.0cm × 3.0cm × 40cm, the tumor involving the anterior optic chiasm, the left lateral carotid artery, and saddle behind the development of the block to be divided Full removal. Postoperative pathology report as “craniopharyngioma.” Six hours after operation, the patients developed palpitation, chest tightness and irritability. The blood pressure was 20 / 14KPa and the pulse rate was 180 beats / And the CO 2 binding rate was 21mmol / L. After that, Na ~ + increased progressively. The highest postoperative day was 190.9mmol / L, the blood osmolality reached to 347mmol / L, and the lowest CO 2 binding rate was found to be 4.15,158.3,123mmol /