National Institute of Nursing Education (NINE), PGIMER, Chandigarh, India.
Department of Endocrinology, PGIMER, Chandigarh, India.
J Adv Nurs. 2021 Sep;77(9):3911-3920. doi: 10.1111/jan.14894. Epub 2021 May 24.
To test the effectiveness of nurse-led dietary diabetes insipidus (DI) bundle on the severity of postoperative fluid imbalance in pituitary region tumours.
Blinded randomized controlled trial.
Patients aged 18-65 operated for sellar-suprasellar tumours in an Indian tertiary care centre were enrolled through total enumeration sampling and underwent randomization with allocation concealment during Sep 2018-Feb 2019. Pre-operative DI, postoperative ventilation, renal failure or decompensated diabetes mellitus were excluded. Patients in the intervention group received a nurse-led DI bundle (validated by three Delphi rounds) with four dietary components: intake of only water during thirst and avoidance of the following-added salt, high-protein foods and caffeinated drinks. Treating clinicians and the investigator assessing outcome were blinded about enrolment. Urine output, serum sodium, vasopressin requirement and hospital stay were assessed as primary outcomes. The outcome measures were monitored daily till the 6th postoperative day. Analyses were performed on 'intention-to-treat' basis, irrespective of compliance. Independent t-test and Chi-square test were used.
Of the initial 63 patients, 50 fulfilling criteria were randomized to two groups and assessed over six days yielding 150 patient-days per group. There were no significant baseline differences between groups. The mean daily urine output was significantly lower in the DI bundle group than in control, both overall and among endonasal operated pituitary adenomas [3000.09(462.7) vs. 4095.71(896.4)ml & 2987.14(419.5) vs. 4064.73(1051)ml], with the greatest difference on the second postoperative day. Though hypernatraemia in controls became most prominent during days 2-3 and resolved in a week, it was significantly lower in the intervention group (12.7% vs. 30.7% overall, 11.4% vs. 29.4% endonasal adenomas). The need for vasopressin analogues and hospital stay were also significantly lower with DI bundle (p < 0.001).
This is probably the first ever report of dietary DI bundle among operated pituitary patients, which seem to flatten the DI trend with significant benefits in polyuria, hypernatraemia, vasopressin requirement and hospital stay.
CTRI/2018/07/015127 of ICMR.
The nurse-led dietary DI bundle has effectively reduced the severity of DI among operated pituitary patients with significant benefits in polyuria, hypernatraemia, vasopressin requirement and hospital stay. Its implementation is simple and easy to carry out, especially in resource-constrained institutions, where continuous monitoring and repeated serum sodium estimation are difficult.
检验护士主导的饮食性尿崩症（DI）护理包对垂体区肿瘤术后液体失衡严重程度的影响。
盲法随机对照试验。
通过整群抽样纳入 2018 年 9 月至 2019 年 2 月在印度一家三级护理中心接受鞍区-颅咽管瘤切除术的 18-65 岁患者，并采用分配隐藏法进行随机分组。排除术前 DI、术后通气、肾衰竭或失代偿性糖尿病患者。干预组患者接受由三名 Delphi 专家验证的护士主导的 DI 护理包（通过三轮 Delphi 专家咨询验证），其中包含四个饮食成分：口渴时摄入仅水并避免添加盐、高蛋白食物和含咖啡因的饮料。治疗临床医生和评估结果的研究者对入组情况不知情。尿输出量、血清钠、血管加压素需求和住院时间被评估为主要结局。术后第 6 天每天监测结局指标。分析采用意向治疗（intention-to-treat）原则，不考虑依从性。采用独立 t 检验和卡方检验。
最初的 63 名患者中，符合标准的 50 名患者被随机分为两组，并在六天内进行评估，每组患者均获得 150 个患者日。两组患者的基线差异无统计学意义。与对照组相比，DI 护理包组患者的平均日尿量明显减少，无论总体情况还是经鼻蝶入路垂体腺瘤患者，差异均有统计学意义[3000.09(462.7) vs. 4095.71(896.4)ml 和 2987.14(419.5) vs. 4064.73(1051)ml]，术后第 2 天差异最大。虽然对照组的高钠血症在第 2-3 天最为明显，并在一周内得到缓解，但干预组的高钠血症发生率显著较低（总体 12.7% vs. 30.7%，经鼻蝶入路垂体腺瘤 11.4% vs. 29.4%）。DI 护理包也显著降低了血管加压素类似物的需求和住院时间（p<0.001）。
这可能是首次报道垂体瘤术后患者的饮食性 DI 护理包，该护理包可能会减轻 DI 趋势，明显改善多尿、高钠血症、血管加压素需求和住院时间。
ICMR 的 CTRI/2018/07/015127。
护士主导的饮食性 DI 护理包有效减轻了垂体瘤术后患者 DI 的严重程度，多尿、高钠血症、血管加压素需求和住院时间均得到显著改善。该护理包的实施简单易行，尤其适用于资源有限的机构，这些机构难以进行连续监测和反复血清钠评估。
