老年性夜尿症的抗利尿治疗

夜尿症是老年人最常见的问题之一,在50岁以上的人群中,随着年龄的增长其发生更为普遍,当前社会人口老龄化趋势加深,老年性夜尿症随之受到临床关注,已有多项研究发现,老年性夜尿症与体内抗利尿激素分泌节律异常有关[1]。抗利尿激素治疗在老年夜尿症的治疗中的地位逐渐显现。

神经外科抗利尿激素分泌不当综合征的诊断与治疗

【目的】探讨神经外科抗利尿激素分泌不当综合征(SIADH)的可能发生机制、诊断思路、鉴别诊断及抢救治疗方法。【方法】回顾分析 24 例 SIADH的临床诊治过程并进行文献复习。【结果】SIADH的特点为:①低血钠(血钠≤130 mmol/L);②低血渗(血浆渗透压≤270 mmol/L);③高尿钠(≥80 mmol/L);④中心静脉压正常或稍升高;⑤肾功能正常。【结论】在神经外科低钠血症的诊治过程中,在经过补充钠盐后仍有低钠血症者,应考虑SIADH存在的可能,需进一步明确诊断,SIADH与脑性盐耗综合征的鉴别非常重要。

阿托西班治疗前置胎盘40例疗效观察

目的:探讨阿托西班治疗未足月前置胎盘患者的临床效果及不良反应。方法:90例未足月前置胎盘患者随机分为两组,观察组40例给予静滴阿托西班维持治疗,对照组50例给予利托君静滴维持治疗,观察两组患者症状缓解时间,妊娠延迟时间及不良反应发生率。结果:两组症状缓解时间分别为37.2±6.7mim和51.8±10.3min,妊娠延迟时间分别为40.25±22.4d和32.56±7.86d,有效率分别为100%、78%,不良反应的比例分别为7.5%和32%,两组比较差异均有统计学意义(P<0.05)。结论:阿托西班对前置胎盘患者治疗效果优于利托君,不良反应发生率低,具有更好的临床疗效。

脑性盐耗损综合征的诊断和治疗

【目的】探讨脑性盐耗损综合征的病因、诊断及治疗方法。【方法】对29例发生脑性盐耗损综合征的病人的临床特征进行回顾性分析。【结果】经及时诊治，29例患者均于病后9～17d后血钠及尿量恢复正常，病情好转。【结论】脑性盐耗损综合征可见于脑肿瘤术后，自发性蛛网膜下腔出血及脑外伤患者，经及时诊断与正确处理，可获得良好的效果。

Diagnosis and therapy of ascites in liver cirrhosis

Ascites is one of the major complications of liver cirrhosis and is associated with a poor prognosis. It is important to distinguish noncirrhotic from cirrhotic causes of ascites to guide therapy in patients with noncirrhotic ascites. Mild to moderate ascites is treated by salt restriction and diuretic therapy. The diuretic of choice is spironolactone. A combination treatment with furosemide might be necessary in patients who do not respond to spironolactone alone. Tense ascites is treated by paracentesis, followed by albumin infusion and diuretic therapy. Treatment options for refractory ascites include repeated paracentesis and transjugular intrahepatic portosystemic shunt placement in patients with a preserved liver function. Potential complications of ascites are spontaneous bacterial peritonitis (SBP) and hepatorenal syndrome (HRS). SBP is diagnosed by an ascitic neutrophil count > 250 cells/mm3 and is treated with antibiotics. Patients who survive a first episode of SBP or with a low protein concentration in the ascitic fluid require an antibiotic prophylaxis. The prognosis of untreated HRS type 1 is grave. Treatment consists of a combination of terlipressin and albumin. Hemodialysis might serve in selected patients as a bridging therapy to liver transplantation. Liver transplantation should be considered in all patients with ascites and liver cirrhosis.