儿童颅咽管瘤术后水电解质紊乱的管理方案

目的 探讨儿童颅咽管瘤术后水电解质紊乱的管理方案。方法 回顾性分析2016年12月到2019年5月手术治疗的56例儿童颅咽管瘤的临床资料。术后高钠血症使用生理盐水补充每日钠需要量+5%葡萄糖溶液降血钠，术后出现重度低钠血症使用3%盐水微量泵持续补钠。结果 术后出现尿崩症40例（71.4%），电解质紊乱30例（53.6%）。高钠血症患儿治疗第一天血钠波动幅度平均为（7.8±2.0） mmol/L，第二天平均为（5.9±2.2） mmol/L，控制时间平均（76.5±11.7）h。重度低钠血症患儿治疗第一天波动幅度平均为（7.7±2.0） mmol/L，第二天平均为（7.5±3.1） mmol/L，控制时间平均（89.8±14.2）h。治疗过程中，未出现意识障碍、癫痫、脱髓鞘等并发症。出院时，40例尿崩症患儿的尿量得到控制，30例电解质紊乱患儿连续3次血清Na+正常。结论 儿童颅咽管瘤术后电解质紊乱发生率高，稳定血清钠波动幅度，有助于改善病人预后。

Management of water and electrolyte disturbances in children with craniopharyngioma after surgery

Objective To explore the management of water and electrolyte disturbances in children with craniopharyngioma after operation. Methods The clinical data of 56 children with craniopharyngioma who underwent surgery from December 2016 to May 2019 were retrospectively analyzed. For postoperative hypernatremia, 0.9% normal saline was used to supplement daily sodium requirement and 5% glucose solution was used to reduce serum sodium. For postoperative severe hyponatremia, 3% sodium chloride solution was used to supplement the serum sodium. Results Diabetes insipidus occurred in 40 patients (71.4%) and electrolyte disturbance in 30 (53.6%) after operation. In children with hypernatremia, The mean fluctuation range of serum sodium was (7.8±2.0) mmol/L at first day of the treatment and (5.9±2.2) mmol/L at the second day, and the average control time of serum sodium was (76.5±11.7) h. In in children with hyponatremia, the mean fluctuate range of serum sodium was (7.7±2.0) mmol/L at first day of the treatment and (7.5±3.1) mmol/L at the second day, and the average control time of serum sodium was (89.8±14.2) h. Conclusions The incidence of electrolyte disturbance is high in the children with craniopharyngioma after surgery. The prognosis of patients can be significantly improved by stabilizing the fluctuation range of serum sodium.