Keating Olivia, Hale Andrew T, Smith Anastasia A, Jimenez Victoria, Ashraf Ambika P, Rocque Brandon G
Division of Pediatric Neurosurgery, Children's of Alabama, Birmingham, AL, USA.
Division of Pediatric Endocrinology, University of Alabama at Birmingham, Children's of Alabama, Birmingham, AL, USA.
Childs Nerv Syst. 2023 Mar;39(3):617-623. doi: 10.1007/s00381-022-05729-8. Epub 2022 Oct 29.
Hyponatremia after craniotomy can be associated with increased morbidity. However, the incidence of and factors associated with post-craniotomy hyponatremia in children are not known.
We performed a retrospective cohort study of patients aged 0-21 years who underwent craniotomy in 2017-2019 at a single center to determine the incidence of and to identify risk factors for hyponatremia after craniotomy. Indications for craniotomy included tumors (excluding craniopharyngioma), epilepsy, intracranial infection, trauma, craniofacial, suboccipital decompression for the treatment of Chiari malformation, and cerebrovascular disease. Hyponatremia was defined as a serum sodium level ≤ 135 mEq/L any time during the postoperative hospital stay. Statistical significance was defined a priori at p < 0.05.
Postoperative hyponatremia occurred in 61 (25%) of 240 children. On univariate analysis, hyponatremia was associated with younger age (8.5 vs 6.3 years, p = 0.01), use of preoperative anti-epileptic drugs (p = 0.02), need for blood transfusion (p = 0.02), government/private insurance (p = 0.04), and pre-existing hydrocephalus, defined as the requirement for permanent cerebrospinal fluid (CSF) diversion (p = 0.04). On multivariate analysis, only hydrocephalus (OR 2.95, 95% CI 1.03-8.40) remained statistically significant. Hyponatremia most occurred on the first postoperative day, with normonatremia achieved in a median of 14 (IQR 9.8-24.3) h. Hyponatremia was significantly associated with longer length of stay (median 8 vs 3 days, p < 0.01).
Hyponatremia was present in 25% of children after craniotomy. Preoperative hydrocephalus as an independent risk factor for hyponatremia after craniotomy.
开颅术后低钠血症可能与发病率增加有关。然而，儿童开颅术后低钠血症的发生率及相关因素尚不清楚。
我们对2017 - 2019年在单一中心接受开颅手术的0 - 21岁患者进行了一项回顾性队列研究，以确定开颅术后低钠血症的发生率并识别其危险因素。开颅手术的适应证包括肿瘤（不包括颅咽管瘤）、癫痫、颅内感染、创伤、颅面手术、枕下减压治疗Chiari畸形以及脑血管疾病。低钠血症定义为术后住院期间任何时间血清钠水平≤135 mEq/L。统计学显著性预先定义为p < 0.05。
240名儿童中有61名（25%）发生术后低钠血症。单因素分析显示，低钠血症与年龄较小（8.5岁对6.3岁，p = 0.01）、术前使用抗癫痫药物（p = 0.02）、输血需求（p = 0.02）、政府/私人保险（p = ）和既往脑积水（定义为需要永久性脑脊液分流，p = 0.04）有关。多因素分析显示，只有脑积水（OR 2.95，95% CI 1.03 - 8.40）仍具有统计学显著性。低钠血症大多发生在术后第一天，正常血钠水平在中位数14（IQR 9.8 - 24.3）小时内恢复。低钠血症与住院时间延长显著相关（中位数8天对3天，p < 0.01）。
25%的儿童开颅术后出现低钠血症。术前脑积水是开颅术后低钠血症的独立危险因素。
