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目的:分析垂体后叶素对咯血患者血钠影响的临床特点。方法:收集2006年10月至2009年10月首都医科大学附属北京安贞医院急诊重症监护室应用垂体后叶素治疗咯血患者的临床资料,进行回顾性分析。结果:共有14例咯血患者应用垂体后叶素治疗。垂体后叶素的用量为3～5 U,加入0.9%氯化钠注射液20 mL中缓慢静脉推注,之后用垂体后叶素6～12 U+0.9%氯化钠注射液250 mL缓慢静脉滴注,止血后改为垂体后叶素6～12 U+0.9%氯化钠注射液250 mL静脉滴注,维持12～24 h后停药。4例患者使用垂体后叶素1d后止血遂停药,血钠无变化。使用垂体后叶素2～12 d止血后停药的10例患者出现低钠血症[由入院时(137.4±1.3)mmol/L降至(124.9±5.6)mmol/L,P<0.05]。10例患者中男性4例,女性6例,年龄47～79岁,平均62岁。其中9例(用药时间2～9 d,平均4 d)表现为恶心、呕吐、头晕及疲乏,垂体后叶素平均累计总用量为57(24～108)U/人,为轻度低钠血症;1例(用药时间12 d)表现为反应迟钝和昏睡,垂体后叶素累计总用量为124 U,停用垂体后叶素后出现一过性多尿,为重度低钠血症。对低钠血症患者用3%～4%氯化钠注射液静脉滴注补钠治疗,患者血钠由(124.9±5.6)mmol/L升至(138.1±1.2)mmol/L(P<0.05)。经止血和补钠治疗,所有患者康复出院。结论:使用垂体后叶素治疗咯血应密切监测患者临床表现和血钠变化;已经止血并出现低钠血症者应停用垂体后叶素并给予对症治疗。
Objective: To analyze the clinical characteristics of vasopressin on hemoglobin in patients with hemoptysis. Methods: The clinical data of patients with hemoptysis treated with pituitrin in emergency intensive care unit of Beijing Anzhen Hospital, Capital Medical University from October 2006 to October 2009 were retrospectively analyzed. Results: A total of 14 patients with hemoptysis were treated with pituitrin. The amount of pituitrin 3 ~ 5 U, adding 0.9% sodium chloride injection 20 mL slow intravenous injection, followed by vas vasopressin 6 ~ 12 U + 0.9% sodium chloride injection 250 mL slow intravenous Drip, stop bleeding after vasopressin 6 ~ 12 U + 0.9% sodium chloride injection 250 mL intravenous infusion, maintenance of 12 ~ 24 h after withdrawal. 4 cases of patients with pituitrin 1h after stopping the hemostasis, serum sodium unchanged. Hyponatremia [from (137.4 ± 1.3) mmol / L to (124.9 ± 5.6) mmol / L, P <0.05] was observed in 10 patients who received pituitrin 2 to 12 days after stopping the bleeding. Among the 10 patients, 4 were males and 6 were females, aged from 47 to 79 years, with an average of 62 years. Nine of them (nausea, vomiting, dizziness and fatigue) showed a mean cumulative amount of vasopressin of 57 (24-108) U / person for mild to hyponatremia for 2 to 9 days (averaged 4 days) 1 case (d 12 d) showed unresponsiveness and drowsiness. The total amount of vasopressin in the pituitary gland was 124 U. One case of transient polyuria after vasopressin withdrawal was severe hyponatremia. In patients with hyponatremia, 3% ~ 4% sodium chloride injection was used to supplement sodium, the serum sodium level increased from (124.9 ± 5.6) mmol / L to (138.1 ± 1.2) mmol / L ). After hemostasis and sodium supplementation, all patients were discharged. Conclusion: The use of pituitrin for the treatment of hemoptysis should be closely monitored in patients with clinical manifestations and changes in serum sodium; have stopped bleeding and hyponatremia should be disabled pituitrin and given symptomatic treatment.