Madden Jennifer R, Dobyns Emily, Handler Michael, Foreman Nicholas K
Department of Oncology, The Children's Hospital, University of Colorado Medical School, Denver, CO 80218, USA.
J Pediatr Oncol Nurs. 2010 Jan-Feb;27(1):21-3. doi: 10.1177/1043454209340320. Epub 2009 Aug 17.
Children with brain tumors routinely undergo craniotomies for tumor resections. Nurses and nurse practitioners are critical in closely monitoring these patients. Postoperatively, these children may develop inappropriate vasopressin secretion, cerebral salt wasting syndrome, or a combination of both. Inappropriate fluid and electrolyte administration may exacerbate symptoms. Both high and low sodium levels are associated with significant complications. Sodium levels were prospectively observed for 72 hours perioperatively. Overall, 36 patients had 201 serum sodium levels measured over the course of 1 year. Postoperatively, 79 (39%) of the sodium levels were <135 mEq/L or >145 mEq/L. Of these abnormal sodium levels, 3 (1%) were <125 mEq/L and 2 (1%) were >165 mEq/L. All the abnormal sodium levels occurred in patients with suprasellar or hypothalamic lesions. This study suggests that children with resections of suprasellar or hypothalamic tumors need specialist attention in postoperative management of fluid and electrolytes. The nurse is in the ideal role to monitor closely the pediatric brain tumor patient at high risk for abnormal sodium levels.
患有脑肿瘤的儿童通常会接受开颅手术以切除肿瘤。护士和执业护士在密切监测这些患者方面至关重要。术后，这些儿童可能会出现抗利尿激素分泌异常、脑性盐耗综合征或两者兼有的情况。不适当的液体和电解质管理可能会加重症状。高钠水平和低钠水平均与严重并发症相关。围手术期前瞻性观察钠水平72小时。总体而言，36例患者在1年的时间里共检测了201次血清钠水平。术后，79次（39%）钠水平<135 mEq/L或>145 mEq/L。在这些异常钠水平中，3次（1%）<125 mEq/L，2次（1%）>165 mEq/L。所有异常钠水平均发生在鞍上或下丘脑病变的患者中。这项研究表明，接受鞍上或下丘脑肿瘤切除术的儿童在术后液体和电解质管理方面需要专科医生的关注。护士处于理想的角色，能够密切监测钠水平异常风险高的小儿脑肿瘤患者。
