Belzer Jennifer S, Williams Cydni N, Riva-Cambrin Jay, Presson Angela P, Bratton Susan L
1Department of Pediatrics, University of Utah, Salt Lake City, UT. 2Department of Neurosurgery, University of Utah, Salt Lake City, UT. 3Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, UT.
Pediatr Crit Care Med. 2014 Jun;15(5):456-63. doi: 10.1097/PCC.0000000000000154.
To describe the time course, variability, and magnitude of serum sodium changes among children undergoing intracranial tumor surgery.
Retrospective cohort study.
Tertiary children's hospital in Salt Lake City, UT.
Children 0-19 years undergoing first neurosurgical procedure for an intracranial tumor, treated during January 2001 and February 2012.
None.
Three hundred nineteen patients were placed in three exclusive groups based on the lowest serum sodium measurement during admission: 1) severe hyponatremia: serum sodium less than or equal to 130 mEq/L; 2) mild hyponatremia: 131-135 mEq/L; and 3) normal sodium: more than 135 mEq/L. Timing and severity of sodium perturbations were assessed within each group. Hundred thirty-seven patients (43%) had mild hyponatremia, 39 (12%) had severe hyponatremia, and 143 (45%) had normal sodium. After surgery, sodium decreased in all groups with lower averaged concentrations during postoperative days 0-1 and 5-6, although patients with severe hyponatremia had the greatest decline. Nearly 80% of hyponatremic patients had mild hyponatremia prior to development of severe hyponatremia; median time between mild hyponatremia and severe hyponatremia was 1.6 days (interquartile range, 0.4-5.6). Seventy-five percent of patients manifest mild hyponatremia within two postoperative days; however, severe hyponatremia developed later with 75% of patients manifesting severe hyponatremia within six postoperative days. Nine patients had initial severe hyponatremia between days 6 and 20 after surgery. Patients with severe hyponatremia had greater sodium variability with significantly lower nadirs, greater maximum values, and larger decreases within 24-hour periods compared with other sodium groups. Seventy-five percent of children with severe hyponatremia spent more than 4 days with abnormally low sodium values. Among hyponatremic patients, obstructive hydrocephalus and age less than 3.5 years were significant independent risk factors for severe hyponatremia.
Hyponatremia developed in just over half of children. Young children with hydrocephalus have increased risk of severe hyponatremia. Those with severe hyponatremia need frequent and prolonged monitoring because of risk for repeat sodium changes. Further study is needed to evaluate ideal monitoring and treatment of severe hyponatremia after intracranial tumor surgery.
描述接受颅内肿瘤手术患儿血清钠变化的时间进程、变异性及幅度。
回顾性队列研究。
犹他州盐湖城的一家三级儿童医院。
2001年1月至2012年2月期间接受首次颅内肿瘤神经外科手术的0至19岁儿童。
无。
根据入院期间测得的最低血清钠水平，将319例患者分为三个互斥组：1）重度低钠血症：血清钠低于或等于130 mEq/L；2）轻度低钠血症：131 - 135 mEq/L；3）正常钠水平：高于135 mEq/L。评估每组患者钠紊乱的时间和严重程度。137例患者（43%）有轻度低钠血症，39例（12%）有重度低钠血症，143例（45%）钠水平正常。术后，所有组的血清钠均下降，术后第0 - 1天和第5 - 6天平均浓度较低，尽管重度低钠血症患者下降幅度最大。近80%的低钠血症患者在发展为重度低钠血症之前有轻度低钠血症；轻度低钠血症与重度低钠血症之间的中位时间为1.6天（四分位间距为0.4 - 5.6天）。75%的患者在术后两天内出现轻度低钠血症；然而，重度低钠血症出现较晚，75%的患者在术后六天内出现重度低钠血症。9例患者在术后第6至20天出现初始重度低钠血症。与其他钠水平组相比，重度低钠血症患者的钠变异性更大，最低点显著更低，最大值更高，24小时内下降幅度更大。75%的重度低钠血症儿童有超过4天的钠值异常偏低。在低钠血症患者中，梗阻性脑积水和年龄小于3.5岁是重度低钠血症的显著独立危险因素。
超过半数的儿童出现低钠血症。患有脑积水的幼儿发生重度低钠血症的风险增加。由于存在血清钠反复变化的风险，重度低钠血症患者需要频繁且长期的监测。需要进一步研究以评估颅内肿瘤手术后重度低钠血症的理想监测和治疗方法。
