垂体后叶素治疗大咯血致电解质紊乱20例临床分析

Clinical analysis on electrolyte disturbance caused by the employment of hypophysin among twenty patients with massive hemoptysis

目的探讨肺结核并大咯血患者使用垂体后叶素后致电解质紊乱的临床特点及处理情况。方法回顾性分析贵阳医学院第三附属医院感染科2011年1月至2014年6月收治的20例大咯血患者使用垂体后叶素致电解质紊乱及处理情况的临床资料。结果 20例患者中,男8例,女12例,年龄27~59岁,平均为40.2岁,咯血病程为1~10 d,平均4.21 d,合并症为乙肝者2例,社区获得性肺炎者6例,胸膜炎者4例,原发性高血压者2例,支气管扩张症者2例,肺气肿者1例,痰结核菌涂片阳性者5例;使用垂体后叶素前查电解质正常者19例,仅有1例出现低钾血症,所有患者均使用垂体后叶素或是出现严重副反应后改用酚妥拉明或氯丙嗪止血治疗。结论垂体后叶素是肺科大咯血及上消化道大出血等的常用止血药物,其常见副反应为血压升高、腹痛、心绞痛、心动过缓、胸闷等。但使用后发生的低钠、低氯、低钾血症临床上少见,容易被忽视,并有可能因此引起严重药物不良反应事件。

Objective To explore the clinical characteristics and management of electrolyte disturbance caused by the employment of hypophysin among phthisises with massive hemoptysis. Methods From January 2011 to June 2014, Retrospective methods was employed to analyze the clinical data of 20 cases with electrolyte disturbance caused by the employment of hypophysin among phthisises combined massive hemoptysis hospitalized in the third affiliated hospital of Guiyang medical university. Results Our samples consisted of 8 male and 12 female; age ranged from 27 to 59(average age 40.2 years old); course of hemoptysis ranged from 1 to 10 days(average age 4.21± years old); among 20 samples, 2 cases combined with hepatitis B, 6cases combined with communityacquired pneumonia, 4 cases combined with pleuritis; 2 cases combined primary hypertension; 2 cases combined bronchiectasis; 5 cases were found mycobacterium tuberculosis in Sputum; baseline of electrolyte was limited in normal serum concentration in 19 cases, only 1 case had been hypokalemia at the baseline test; phentolamine or chlorpromazine was adapted as hemostasis in total samples after the use of hypophysin or serious side-effects occurred. Conclusion Hypophysin is a routine medicine for hemostasi when massive hemoptysis occurs in pulmonary medicine or happens in the upper alimentary tract, though elevation of blood pressure, stomachache, stenocardia, bradyarrhythmia, chest distress frequently occurs among its side-effects, hyponatremia, hypochloridemia, hypokalemia is liable to be neglected in clinical practice due to its rare frequency. Therefore, much attention should be paid to prevention to serious side-effects of hypophysin, In particular.