肺移植术后高钠血症1例并文献复习  

Management of hypernatremia following lung transplantation: A case report and literature review

作　　者：周鸿敏[1] 石炳毅[1] 张向华[2] 魏福岭[1] 

机构地区：[1]解放军总医院第二附属医院全军器官移植中心,北京市100091 [2]解放军总医院第二附属医院胸心外科,北京市100091

出　　处：《中国组织工程研究与临床康复》2009年第31期6155-6158,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：选择原发性肺动脉高压并三尖瓣关闭不全、充血性心力衰竭患者1例,在体外循环下行同种异体原位双肺移植术,移植后出现严重的持续性高钠血症合并严重代谢性碱中毒。回顾分析其病理过程及诊疗经过,并复习相关文献。患者移植后第1天血钠升高,达158.2mmol/L,第4天达167.9mmol/L,同时合并严重的代谢性碱中毒,最高pH值达7.6。经补充血容量、使用襻利尿剂、控制钠盐摄入综合治疗14d后,血钠恢复正常至140mmol/L,碱中毒纠正,并维持酸碱及电解质平衡。提示肺移植后高钠血症的发生有其特殊性和复杂性,需要积极消除各种易感因素,及时对危重症患者进行病因和对症治疗,尽量减少医源性因素的影响。A case of primary pulmonary hypertension accompanied by tricuspid incompetence and congestive heart failure was employed to perform orthotopic transplantation of bilateral allogenic lung under the extracorporeal circulation. Postoperatively, severe persistent hypematremia accompanied by metabolic alkalosis was present. We retrospectively analyzed the pathological development and reviewed the related literature. Serum sodium level of the patient increased to 158.2 mmol/L at day 1 after transplantation, and reached to 167.9 mmol/L at day 4. Meanwhile, severe metabolic alkalosis occurred, and the pH value reached a peak at 7.6. After 14 days＇ treatment with blood volume replenishment, loop diuretics and sodium intake control, the serum sodium restored to the normal level of 140 mmol/L, the metabolic alkalosis was corrected, and the acid-base and electrolyte maintained a balance. These findings reveal that hypernatremia following lung transplantation has its specialty and complexity. Accordingly, we need to eliminate various predisposing factors, and perform etiological and symptomatic treatments in critical and severe patients correctly and promptly, thereby avoiding negative effects caused by iatrogenic factors.

关 键 词：肺移植 高钠血症 代谢性碱中毒 

分 类 号：R617[医药卫生—外科学]