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目的:分析垂体后叶素致抗利尿激素分泌不当综合征(SIADH)的临床特点和处理方法,以利于安全应用该药。方法:收集2000年1月至2007年12月3所医院应用垂体后叶素治疗咯血患者的临床资料,对符合SIADH诊断患者的血钠、血渗透压、尿钠、尿渗透压、肝肾功能,治疗及转归进行分析。结果:应用垂体后叶素治疗咯血患者共304例,发生SIADH89例,其中男53例,女36例,年龄21～82岁,平均年龄(57.6±21.3)岁。给药方法:先给予垂体后叶素6U入莫菲滴管静脉滴注,然后再以3～6U/h的速度静脉泵入,出血停止后逐渐减量,连续用药2～9d,累计用药剂量76～800U。低钠血症发生于应用垂体后叶素第3～6天,轻度低钠血症(血钠>120～130mmol/L)31例(34.83%),中度低钠血症(血钠>110～120mmol/L)49例(55.06%),重度低钠血症(血钠104～110mmol/L)9例(10.11%)。69例患者出现低钠血症的相关临床症状:倦怠、乏力55例次(36.7%),食欲缺乏、恶心48例次(32.0%),淡漠、头痛、头昏35例次(23.3%),谵妄、抽搐、昏迷12例次(8.0%)。经减少垂体后叶素剂量或停药,限制液体入量及补充氯化钠后,85例患者的血钠恢复正常水平,2例肺癌患者因反复大咯血死亡,另2例出现中心脑桥髓鞘溶解致四肢运动及语言障碍。结论:垂体后叶素可引起抗利尿激素分泌不当综合征,且低钠血症与用垂体后叶素的剂量有关。因此,临床应用垂体后叶素治疗咯血时,其剂量以能控制出血为宜,尽量避免大剂量应用。
Objective: To analyze the clinical features and treatment methods of pituitary vasopressin-induced inappropriate syndrome of vasopressin (SIADH) in order to facilitate the safe use of this medicine. Methods: Clinical data of patients with hemoptysis treated with pituitrin in three hospitals from January 2000 to December 2007 were collected. Serum sodium, blood pressure, urine sodium, urine osmotic pressure, liver and kidney function , Treatment and prognosis analysis. Results: There were 304 cases of hemoptysis with vasopressin. There were 89 cases of SIADH, including 53 males and 36 females, ranging in age from 21 to 82 years with a mean age of (57.6 ± 21.3) years. Dosage: 6U pituitary vasopressin intravenous drip infusion, and then to 3 ~ 6U / h speed intravenous infusion, stop bleeding after gradual reduction, continuous medication 2 ~ 9d, the cumulative dose 76 ~ 800U. Hyponatremia occurred in 3 to 6 days after application of vasopressin, mild hyponatremia (serum sodium> 120-130 mmol / L) in 31 cases (34.83%), moderate hyponatremia (serum sodium> 49 patients (55.06%) had severe hyponatremia (104 ~ 110 mmol / L) and 9 patients (10.11%) had hyponatremia. The clinical symptoms of hyponatremia in 69 patients were: fatigue, fatigue in 55 cases (36.7%), loss of appetite, nausea in 48 cases (32.0%), apathy, headache and dizziness in 35 cases (23.3% Delirium, convulsions, coma 12 cases (8.0%). After reducing the dose of pituitrin or withdrawal, limiting the amount of fluid and sodium chloride supplementation, 85 patients returned to normal levels of serum sodium, 2 patients with lung cancer died of recurrent hemoptysis, the other two cases of central pontine myelin Solubility caused by limb movement and speech impairment. Conclusion: Pituitrin can cause inappropriate secretion of anti-diuretic hormone syndrome, and hyponatremia with vasopressin dose. Therefore, the clinical application of vasopressin treatment of hemoptysis, the dose to be able to control bleeding is appropriate to avoid high-dose applications.