垂体后叶素致抗利尿激素分泌不当综合征89例的回顾性分析

Pituitrin-induced syndrome of inappropriate secretion of antidiuretic hormone:a retrospective analysis of 89 cases

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。

ABSTRACT Objective： To analyse the clinical characteristics and management of syndrome of inappropriate secretion of antidiuretic hormone（SIADH） induced by pituitrin in order to benefit the safe use of pituitrin. Methods： Clinical data from patients with hemoptysis receiving pituitrin from 3 hospitals were collected between January 2000 and December 2007. The serum and urine sodium, plasma and urine osmolality, liver and renal functions, treatment, and outcome were analysed in patients who met the criteria for SIADH. Results： A total of 304 patients with hemoptysis received pituitrin therapy. Of them, 89 patients （53 men and 36 women） with age 21 - 82 years [ average age （57.6± 21.3 ） years ] developed SIADH. The dosage and administration were as follows ： an initial dose of pituitrin 6 U was given via a Murphy＇s dropper, followed by 3 -6 U/h via an infusion pump. After hemorrhage ceased, the dosage of pituitrin was decreased. The durations of treatment were 2 - 9 days. A cumulative dose was 76 - 800 U. Hyponatremia occurred in 3-6 days after starting pituitrin use. Thirty one patients （34.83%） were mild hyponatremia （serum sodium 〉 120 - 130 mmol/L） , 49 patients （55.06%） were moderate hyponatremia （ serum sodium 〉 110 - 120 mmol/L） , and 9 patients （ 10.11% ） were severe hyponatremia （ serum sodium 104 - 110mmol/L）. Sixty-nine patients developed hyponatremia-associated clinical symptoms including lassitude and asthenia in 55 cases （36.7% frequency）, anorexia and nausea in 48 cases （32.0%） , apathy, headache, and dizziness in 35 cases （23.3%）, delirium, convnlsion, and coma in 12 cases （8.0%）. After the dosage decrease or discontinuation of pituitrin, water restriction, and salt administration, 85 patients＇serum sodium level return to within the normal limits, 2 patients with lung cancer died of uncontrolled pulmonary hemorrhage, and the other 2 patients developed central pontine myelinolysis （ CPM ） leading to upper and lower limb dyskinesia and dysphasia. Conclusion： Pituitrin might cause SIADH, and hyponatremia occurring is dose-related. Therefore, a suitable dosage of pituitrin should be the one which can just stop bleeding, and high dosage of pituitrin should be avoided if possible.