本文選題：急性垂體瘤卒中　切入點(diǎn)：臨床癥狀　出處：《山東大學(xué)》2015年碩士論文

【摘要】：目的：報(bào)道急性垂體瘤卒中病例,總結(jié)急性垂體瘤卒中的臨床特征,探討其診斷及治療方法。方法：回顧性分析本科室救治的急性垂體瘤卒中患者的臨床資料,并結(jié)合文獻(xiàn)進(jìn)行復(fù)習(xí)總結(jié)。資料：44歲男性患者1位,頭痛并視物模糊3日余,伴惡心、嘔吐。干預(yù)措施：患者入院后立即給予適量氫化可的松進(jìn)行激素替代治療,同時(shí)完善實(shí)驗(yàn)室(入院系列、垂體系列激素)和影像學(xué)輔助檢查(顱腦CT平掃、垂體MRI平掃+強(qiáng)化),控制體溫,糾正水、電解質(zhì)紊亂。初步糾正病人身體一般情況后,于入院后第3天在全身麻醉下進(jìn)行經(jīng)鼻蝶入路手術(shù)減壓。術(shù)后患者長(zhǎng)期應(yīng)用口服激素替代治療。結(jié)果：患者術(shù)后常規(guī)病理檢查結(jié)果顯示垂體瘤卒中。術(shù)后一般狀況恢復(fù)好,視力及垂體功能顯著改善。結(jié)論：急性垂體瘤卒中是指臨床癥狀在發(fā)病后24h內(nèi)達(dá)到高峰的垂體瘤卒中。垂體腺瘤人群中急性垂體瘤卒中的發(fā)生率約為1.6%-10%,40～50歲是急性垂體瘤卒中的發(fā)病高峰年齡段。急性垂體瘤卒中是由垂體腺瘤瘤內(nèi)突發(fā)出血或缺血梗塞,甚至是缺血梗死后繼發(fā)出血,然后累及鞍旁組織所導(dǎo)致的少見的臨床綜合征,臨床上垂體瘤卒中病人發(fā)病一段時(shí)間后病情可以再次爆發(fā)性進(jìn)展,這可能是由于缺血梗死后繼發(fā)出血所致,應(yīng)該引起足夠重視。急性垂體瘤卒中的癥狀主要包括突然發(fā)作的頭痛,惡心、嘔吐,視力下降,視野缺陷,眼肌麻痹,甚至意識(shí)障礙以及部分或全垂體功能減退等。除此之外,急性垂體瘤卒中還可以引起蛛網(wǎng)膜下腔出血或全身其它系統(tǒng)的并發(fā)癥,是一種臨床危重癥。盡管如此,急性垂體瘤卒中經(jīng)過及時(shí)得當(dāng)?shù)奶幹檬强梢垣@得痊愈的。垂體大腺瘤或巨大腺瘤更容易發(fā)生出血,從而引起垂體瘤卒中,無功能腺瘤早期難以被發(fā)現(xiàn),更容易發(fā)展為大腺瘤或巨大腺瘤,從而增加了發(fā)生卒中出血的風(fēng)險(xiǎn)。垂體瘤卒中的發(fā)病急性期最為實(shí)用的影像學(xué)輔助檢查是CT掃描,診斷急性垂體瘤卒中最理想的影像學(xué)輔助檢查手段是垂體MRI檢查。對(duì)于急性垂體瘤卒中患者,尤其是對(duì)視力急劇下降或存在意識(shí)障礙的患者,糾正一般情況后盡快手術(shù)減壓是術(shù)后視力恢復(fù)和保護(hù)垂體功能的前提條件,急性垂體瘤卒中發(fā)病1周以內(nèi)進(jìn)行手術(shù)治療的病人比發(fā)病1周后進(jìn)行手術(shù)的病人具有更高的視力改善比率,急性垂體瘤卒中患者手術(shù)減壓時(shí)的首選入路是經(jīng)鼻蝶入路。在圍手術(shù)期特別是手術(shù)前進(jìn)行早期激素替代治療和及時(shí)控制中樞性高熱,糾正水、電解質(zhì)平衡紊亂在患者的預(yù)后中發(fā)揮著重要作用。對(duì)于急性垂體瘤卒中患者的治療是終生性的,超過一半的患者需要一種或多種垂體激素進(jìn)行終生激素替代治療。
[Abstract]:Objective: to report the cases of acute pituitary apoplexy, summarize the clinical features of acute pituitary apoplexy, and discuss its diagnosis and treatment. Methods: the clinical data of acute pituitary apoplexy treated in our department were analyzed retrospectively. Data: 1 male, 44 years old, had headache and blurred vision for more than 3 days, accompanied by nausea and vomiting. Intervention measures: patients were given appropriate amount of hydrocortisone for hormone replacement therapy immediately after admission. At the same time, the laboratory (admission series, pituitary hormone series) and imaging auxiliary examination (craniocerebral CT plain scan, pituitary MRI plain scan enhancement, body temperature control, water and electrolyte disturbance correction) and imaging auxiliary examination (brain CT plain scan, pituitary MRI plain scan) were improved. On the third day after admission, the patients were decompressed by transsphenoidal approach under general anesthesia. The patients were treated with oral hormone replacement therapy for a long time. Conclusion: acute pituitary apoplexy refers to pituitary adenoma apoplexy whose clinical symptoms peak within 24 hours after onset. The incidence of acute pituitary apoplexy in pituitary adenoma population is about 1.6-104050 years old is acute. Acute pituitary apoplexy is caused by sudden hemorrhage or ischemic infarction in pituitary adenoma. Even the rare clinical syndrome caused by secondary bleeding after ischemic infarction and then involvement of the parasellar tissue, may occur again after the onset of pituitary adenoma stroke for a period of time. This may be due to secondary bleeding after ischemic infarction, and should be taken into account. Symptoms of acute pituitary adenoma stroke include sudden onset of headache, nausea, vomiting, impaired vision, visual field defect, ophthalmoplegia. In addition, acute pituitary apoplexy can cause subarachnoid hemorrhage or complications of other systemic systems. Acute pituitary apoplexy can be cured with timely and proper treatment. Large pituitary adenomas or giant adenomas are more likely to bleed, leading to pituitary apoplexy, which is difficult to detect in the early stages of nonfunctioning adenomas. It is more likely to develop into macroadenomas or giant adenomas, which increases the risk of bleeding from stroke. The most useful imaging aids for pituitary apoplexy are CT scans. The most ideal imaging adjuvant for the diagnosis of acute pituitary apoplexy is pituitary MRI. Surgical decompression as soon as possible after correcting the general situation is a prerequisite for the recovery of visual acuity and the protection of pituitary function. Patients with acute pituitary apoplexy who underwent surgery less than one week after the onset of acute pituitary adenoma had a higher rate of visual improvement than those who underwent surgery one week after the onset of acute pituitary adenoma. Transsphenoidal approach is the preferred approach for patients with acute pituitary adenoma apoplexy. Early hormone replacement therapy and timely control of central hyperthermia are performed during the perioperative period, especially before surgery, to correct water. Electrolyte imbalance plays an important role in the prognosis of patients. The treatment of acute pituitary apoplexy is life-long, and more than half of the patients need one or more pituitary hormone for life-long hormone replacement therapy.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R736.4

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