Simon Sonu Kalappurakkal, Pavithran Praveen Valliyaparambil, Asirvatham Aldyne Reena, Ayyadurai R, Parasuram A
Department of Health System Research, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
Department of Endocrinology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
Indian J Endocrinol Metab. 2018 Mar-Apr;22(2):191-195. doi: 10.4103/ijem.IJEM_647_17.
The primary objective of this study was to evaluate the application of principles of quantitative analysis to assess disorders of water balance following surgeries for sellar and suprasellar masses and also to investigate potential factors influencing the occurrence and course of these disorders.
A total of 36 consecutive adult patients who underwent surgery for sellar and suprasellar masses between 2014 and 2015 were prospectively followed up in this observational study. Twenty-one patients had complete laboratory parameter records for quantitative analysis. Clinical parameters, daily fluid balance, and sodium balance were calculated based on the fluid chart and the estimation of sodium concentration of fluids and urine. Classical Edelman equation was used to predict the sodium values. Time course of these disorders and association with etiological and other clinical parameters were assessed. Standard institutional protocol was used in the management of patients studied.
Comparison between predicted values of quantitative analysis and observed values of sodium showed that 80-95% of the observed readings on various days showed concordance with calculated reading, with <5% error. 77.7% manifested at least one episode of dynatremia relating to water balance disorder during the postoperative period. Postoperative diabetes insipidus (DI) observed in 58% of patients, whereas syndrome of inappropriate antidiuretic hormone secretion observed in 47% of patients. Both DI and SIADH in different time points were noticed in 28%, and classical triple phase response was seen in 2.7%. Nearly 83% manifested one episode of dynatremia relating to water balance disorder during the post-operative period. Prolonged DI was noted in 11% and no case of cerebral salt wasting was observed in any of the patients studied.
We observed high degree of correlation between the predicted and observed sodium values. Quantitative analysis in the management of patients with disorders of water balance in postsurgical settings in neurosurgery has the potential for improving clinical care.
本研究的主要目的是评估定量分析原则在评估鞍区和鞍上区肿物手术后水代谢平衡紊乱中的应用，并调查影响这些紊乱发生及病程的潜在因素。
在这项观察性研究中，对2014年至2015年间连续36例接受鞍区和鞍上区肿物手术的成年患者进行了前瞻性随访。21例患者有完整的实验室参数记录用于定量分析。根据液体出入量表以及对液体和尿液中钠浓度的估算，计算临床参数、每日液体平衡和钠平衡。使用经典的埃德尔曼方程预测钠值。评估这些紊乱的时间进程以及与病因和其他临床参数的关联。研究中使用标准的机构方案对患者进行管理。
定量分析预测值与钠观察值的比较显示，不同日期80% - 95%的观察读数与计算读数一致，误差<5%。77.7%的患者在术后出现至少一次与水代谢平衡紊乱相关的电解质紊乱。58%的患者术后出现尿崩症（DI），47%的患者出现抗利尿激素分泌不当综合征（SIADH）。28%的患者在不同时间点同时出现DI和SIADH，2.7%的患者出现经典的三相反应。近83%的患者在术后出现一次与水代谢平衡紊乱相关的电解质紊乱。11%的患者出现持续性DI，研究的任何患者均未观察到脑性盐耗综合征病例。
我们观察到预测钠值与观察钠值之间存在高度相关性。神经外科手术后水代谢平衡紊乱患者管理中的定量分析具有改善临床护理的潜力。
