Castle-Kirszbaum Mendel, Goldschlager Tony, Shi Margaret D Y, Kam Jeremy, Fuller Peter J
Department of Neurosurgery, Monash Health, Melbourne, Australia.
Department of Neurosurgery, Monash Health, Melbourne, Australia; Department of Surgery, Monash University, Melbourne, Australia.
J Clin Neurosci. 2022 Dec;106:180-184. doi: 10.1016/j.jocn.2022.10.032. Epub 2022 Nov 9.
Hyponatremia is a common and potentially dangerous complication of transsphenoidal surgery. Prophylactic postoperative fluid restriction has been trialled as a method to reduce the incidence of postoperative hyponatremia.
A systematic review of the literature was performed in accordance with the PRISMA statement. Risk of bias was assessed using the MINORS criteria. Meta-analysis was performed using the random-effects model.
A total of 6 retrospective cohort studies were available for analysis. Fluid restriction was commonly between 1000 and 1500 ml/day and limited to the first postoperative week. Overall, the rate postoperative hyponatremia was fourfold less in the fluid restricted cohorts (3.4 % vs 11.2 %, OR 0.24 (95 %CI 0.15-0.38), p < 0.01). There was no difference in readmission rates (1.4 % vs 3.9 %, OR 0.32 (95 %CI 0.09-1.13), p = 0.08) or postoperative diabetes insipidus (14.5 % vs 18.6 %, OR 0.82 (95 %CI 0.50-1.36), p = 0.45) between fluid restricted and control cohorts.
Prophylactic postoperative fluid restriction is a cheap, easily implemented intervention that appears to reduce the rate of postoperative hyponatremia, but not necessarily re-admission rates. Whether these prevented cases of hyponatremia are clinically significant remains to be demonstrated.
低钠血症是经蝶窦手术常见且可能危险的并发症。术后预防性限液已作为一种降低术后低钠血症发生率的方法进行了试验。
按照PRISMA声明对文献进行系统评价。使用MINORS标准评估偏倚风险。采用随机效应模型进行荟萃分析。
共有6项回顾性队列研究可供分析。限液量通常为每天1000至1500毫升，且仅限于术后第一周。总体而言，限液组术后低钠血症发生率降低了四倍（3.4%对11.2%，OR 0.24（95%CI 0.15 - 0.38），p < 0.01）。限液组与对照组在再入院率（1.4%对3.9%，OR 0.32（95%CI 0.09 - 1.13），p = 0.08）或术后尿崩症发生率（14.5%对18.6%，OR 0.82（95%CI 0.50 - 1.36），p = 0.45）方面无差异。
术后预防性限液是一种廉价且易于实施的干预措施，似乎可降低术后低钠血症的发生率，但不一定能降低再入院率。这些预防的低钠血症病例是否具有临床意义仍有待证实。
