Yu Siyuan, Taghvaei Mohammad, Reyes Maikerly, Piper Keenan, Collopy Sarah, Gaughan John P, Prashant Giyarpuram N, Karsy Michael, Evans James J
Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Clin Neurol Neurosurg. 2022 Mar;214:107166. doi: 10.1016/j.clineuro.2022.107166. Epub 2022 Feb 10.
Delayed symptomatic hyponatremia (DSH) is an unpredictable postoperative complication after transsphenoidal pituitary surgery. Universal postoperative sodium screening and water restriction are two strategies to detect or prevent the development of DSH. We performed a meta-analysis of studies characterizing the rate of DSH using sodium screening and water restriction protocols.
Literature search was done using MEDLINE/PUBMED, EMBASE, and Cochrane databases. Inclusion criteria are (1) development of DSH after endoscopic or microscopic transsphenoidal, sellar surgery, and (2) reporting of a standardized postoperative sodium screening protocol for monitoring or prevention of DSH.
A total of 23 publications fulfilled the inclusion criteria resulted in a total of 5870 patients. Two meta-analyses were conducted. Of the 19 studies (N = 4488 patients) examining rate of DSH after sodium screening, DSH rates ranged from 0% to 19.7%. In the first meta-analysis, using a random-effect estimate of the combined proportions, the overall rate of DSH was 5.60% (4.0%-7.1%, I = 96.54%, T = 0.0007). In the second meta-analysis, a fixed-effect model of four studies consisted of 1382 patients. Eight hundred fifty-two patients were included prior to and 530 were included after water restriction protocol. Meta-analysis showed an odds ratio (OR) of 5.02 (95% CI: 2.16-11.65) favoring water restriction.
This meta-analysis summarized rates of DSH with sodium screening protocol to be 5.60% (4.0%-7.1%) and showed a decreased risk of DSH after implementation of a water restriction protocol. The results are limited due to few studies examining fluid restriction (N = 4) and heterogeneity in water restriction protocols. No adverse events were seen with fluid restriction protocol. Prospective and multicenter studies should be conducted to further investigate the utility of water restriction following transsphenoidal pituitary surgery.
迟发性症状性低钠血症（DSH）是经蝶窦垂体手术后一种不可预测的术后并发症。术后常规钠筛查和限水是检测或预防DSH发生的两种策略。我们对使用钠筛查和限水方案来描述DSH发生率的研究进行了荟萃分析。
使用MEDLINE/PUBMED、EMBASE和Cochrane数据库进行文献检索。纳入标准为：（1）在内镜或显微镜下经蝶窦鞍区手术后发生DSH；（2）报告用于监测或预防DSH的标准化术后钠筛查方案。
共有23篇出版物符合纳入标准，涉及5870例患者。进行了两项荟萃分析。在19项研究（N = 4488例患者）中，这些研究检测了钠筛查后DSH的发生率，DSH发生率在0%至19.7%之间。在第一项荟萃分析中，采用合并比例的随机效应估计，DSH的总体发生率为5.60%（4.0% - 7.1%，I = 96.54%，T = 0.0007）。在第二项荟萃分析中，四项研究采用固定效应模型，共1382例患者。限水方案实施前纳入852例患者，实施后纳入530例患者。荟萃分析显示，支持限水的优势比（OR）为5.02（95% CI：2.16 - 11.65）。
这项荟萃分析总结出钠筛查方案下DSH的发生率为5.60%（4.0% - 7.1%），并表明实施限水方案后DSH风险降低。由于研究限水的研究较少（N = 4）且限水方案存在异质性，结果受到限制。限水方案未观察到不良事件。应开展前瞻性多中心研究，以进一步探究经蝶窦垂体手术后限水的效用。
