Yokota Kazuki, Uchida Hiroo, Shirota Chiyoe, Tainaka Takahisa, Sumida Wataru, Makita Satoshi, Amano Hizuru, Nakagawa Yoichi, Maeda Takuya, Gohda Yousuke, Kato Daiki, Hinoki Akinari
Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
Department of Pediatric Surgery, Aichi Developmental Disability Center Central Hospital, Kasugai, Aichi, Japan.
Pediatr Int. 2025 Jan-Dec;67(1):e70016. doi: 10.1111/ped.70016.
In Japan, the administration of extra-hypotonic fluids (approximately 35 mmol/L of sodium) as maintenance fluid is still the mainstream practice, and there have been relatively few reports on maintenance intravenous fluid therapy. Since 2014, our institution has administered maintenance fluids containing 83 mmol/L of Na (HALF) after diuresis is achieved post-Kasai portoenterostomy for biliary atresia (BA). We investigated whether hyponatremia is induced by the administration of half saline during postoperative maintenance of infants with BA.
Patients who underwent surgery for BA at our institution were included. The serum sodium concentration ([Na]) before and after surgery and the incidence of hyponatremia were compared between patients administered fluids with [Na] of 35 mmol/L (exHYPO group, 59 patients) and those with [Na] of 83 mmol/L (HALF group, 20 patients).
The median age of patients was 59 days. There were no significant differences in the background or preoperative [Na] between groups. There was a significant decrease in [Na] on postoperative day 3 (POD3) in the exHYPO group compared with the preoperative [Na] value in the exHYPO group and the [Na] value on POD3 in the HALF group. There were no significant differences in [Na] before and after surgery in the HALF group. The odds ratio was 21.0, and the 95% confidence interval was 3.31-130, indicating that the exHYPO group had an increased risk of hyponatremia.
Administration of half saline as maintenance fluid can maintain [Na] levels during postoperative care of infants with BA.
在日本，使用低渗液（钠浓度约为35 mmol/L）作为维持液仍是主流做法，关于维持性静脉输液治疗的报道相对较少。自2014年以来，我们机构在为胆道闭锁（BA）患儿进行开腹肝门空肠吻合术后利尿后，一直使用含83 mmol/L钠（HALF）的维持液。我们调查了在BA患儿术后维持治疗期间给予半张盐水是否会诱发低钠血症。
纳入在我们机构接受BA手术的患者。比较给予钠浓度为35 mmol/L液体的患者（低渗组，59例）和给予钠浓度为83 mmol/L液体的患者（HALF组，20例）手术前后的血清钠浓度（[Na]）以及低钠血症的发生率。
患者的中位年龄为59天。两组之间的背景情况或术前[Na]无显著差异。与低渗组术前[Na]值及HALF组术后第3天（POD3）的[Na]值相比，低渗组术后第3天[Na]显著降低。HALF组手术前后的[Na]无显著差异。优势比为21.0，95%置信区间为3.31 - 130，表明低渗组发生低钠血症的风险增加。
在BA患儿术后护理期间，使用半张盐水作为维持液可维持[Na]水平。
