Xing Mao-Wei, Zhang Yue, Zhu Hui-Ting, Liu Chang, Geng Zhi-Yu, Song Lin-Lin, Wang Dong-Xin
Department of Anesthesiology, Peking University First Hospital, Beijing, China.
Department of Anesthesiology, Beijing Friendship Hospital of Capital Medical University, Beijing, China.
BMC Pediatr. 2025 Mar 15;25(1):195. doi: 10.1186/s12887-025-05543-6.
Whether intraoperative isotonic balanced maintenance fluid is associated with less variation in sodium homeostasis in small children undergoing major neurosurgery remains unknown.
Patients aged up to 6 years undergoing major neurosurgery were randomly assigned to receive either isotonic balanced solution (IB) or 0.2% hypotonic solution (H) as intraoperative maintenance fluid. Serum electrolyte levels were measured from preoperative baseline to 6 d following surgery.
Eighty patients were included in the primary analysis. Serum sodium change was significantly less in the IB patients from the end of surgery continuing to 24 h following surgery (at the end of surgery: -1.4 ± 3.6 versus - 4.6 ± 3.5 mmol/l, P < 0.001; 24 h post: -1.2 ± 4.8 versus - 3.4 ± 2.5 mmol/l, P = 0.028). Twenty (50%) of the IB patients and 25 (63%) of the H patients had serum sodium change > 2.5 mmol/l 24 h following surgery (6.0 ± 3.4 versus 4.8 ± 2.1 mmol/l), with 13 (33%) of the IB patients and 25 (63%) of the H patients having sodium decrease > 2.5 mmol/l (6.4 ± 3.7 versus 4.8 ± 2.1 mmol/l) (P = 0.007). Seven patients in group IB experienced an increase in blood sodium levels exceeding 2.5 mmol/l (median, 4.1 [range 2.7 ∼ 9.2] mmol/l). Notably, 10 (25%) of the IB patients and 6 (15%) of the H patients had sodium variation > 5 mmol/l (median, 8.5 [range 5.1 ∼ 14.6] versus 7.2 [range 5.5 ∼ 11.1] mmol/l). Immediately following surgery till 24 h postoperatively, hyponatremia was less observed in the IB patients compared with that in the H patients. The IB patients had higher hemoglobin levels and less diuresis 48 h postoperatively. No symptoms including altered mental status, seizure, and circulatory overload were observed in all patients.
Intraoperative isotonic balanced solution infusion resulted in statistically but not clinically minimal variation of sodium homeostasis and hemoglobin level postoperatively in small children undergoing major neurosurgery, compared to the use hypotonic solution. Potentially excessive sodium fluctuation following isotonic balanced maintenance fluid infusion should be cautioned, even for a brief period of infusion.
Chinese Clinical Trial Registry ( http://www.chictr.org.cn/ ).
ChiCTR2100046539. Registration date: May 21, 2021. Principal investigator: Lin-Lin Song.
对于接受大型神经外科手术的小儿患者，术中输注等渗平衡维持液是否与钠稳态变化较小相关尚不清楚。
将年龄≤6岁接受大型神经外科手术的患者随机分配，术中维持液分别给予等渗平衡溶液（IB）或0.2%低渗溶液（H）。测量术前基线至术后6天的血清电解质水平。
80例患者纳入初步分析。从手术结束至术后24小时，IB组患者血清钠变化显著小于H组（手术结束时：-1.4±3.6 vs -4.6±3.5 mmol/L，P<0.001；术后24小时：-1.2±4.8 vs -3.4±2.5 mmol/L，P=0.028）。术后24小时，20例（50%）IB组患者和25例（63%）H组患者血清钠变化>2.5 mmol/L（6.0±3.4 vs 4.8±2.1 mmol/L），13例（33%）IB组患者和25例（63%）H组患者钠降低>2.5 mmol/L（6.4±3.7 vs 4.8±2.1 mmol/L）（P=0.007）。IB组7例患者血钠水平升高超过2.5 mmol/L（中位数，4.1[范围2.7～9.2]mmol/L）。值得注意的是，10例（25%）IB组患者和6例（15%）H组患者钠变化>5 mmol/L（中位数，8.5[范围5.1～14.6]vs 7.2[范围5.5～11.1]mmol/L）。术后24小时内，与H组患者相比，IB组患者较少发生低钠血症。IB组患者术后48小时血红蛋白水平较高，尿量较少。所有患者均未出现包括精神状态改变、癫痫发作和循环超负荷在内的症状。
与使用低渗溶液相比，接受大型神经外科手术的小儿患者术中输注等渗平衡溶液导致术后钠稳态和血红蛋白水平的变化在统计学上有差异，但临床差异不明显。即使是短暂输注等渗平衡维持液，也应警惕可能出现的钠波动过大情况。
中国临床试验注册中心（http://www.chictr.org.cn/）。
ChiCTR2100046539。注册日期：2021年5月21日。主要研究者：宋琳琳。
