重症患者恢复期特发性多尿分析  

A study of critical patients with hyperuresis in recovery phase

作　　者：高浩骞 虞文魁[1] 李宁[1] 黎介寿[1] 

机构地区：[1]南京大学医学院临床学院(南京军区南京总医院)解放军普通外科研究所,南京医学硕士研究生210002

出　　处：《医学研究生学报》2014年第3期254-257,共4页Journal of Medical Postgraduates

基　　金：国家自然科学基金(81270884);全军十二五重大课题(AWS12J001)

摘　　要：目的特发性多尿是重症患者常见的并发症，目前国内外缺少对这一类型多尿症的研究报道。本文探讨部分重症患者在多器官功能障碍综合征（muhiple organ dysfunction syndrome，MODS）逐渐好转、病程进入恢复期时突发多尿患者的临床与治疗特点。方法回顾性分析2006年1月至2013年6月南京军区南京总医院ICU突发多尿的临床资料。结果共15例患者纳入研究，入ICU第1天急性生理与慢性健康评分（acute physiology and chronic health evaluation，APACHEII）评分为（24．34-5．7）分，多尿发病第1天为（16．1±5．5）分；在病情好转后第3-14天出现多尿，症状持续时间为（18．3±9．6）d，尿量高峰达（81±17）mL／（kg·d）；多尿发病时血肌酐（101±22）μmol／L、血钾（2．7±0．4）mmol／L且排出尿液为低渗尿。其中6例以垂体后叶素治疗，当垂体后叶素用量达（0．74±0．33）U／h时，可明显降低尿量。15例全部治愈。结论重症患者在MODS严重应激后期出现的多尿与尿崩症、ARF多尿期等常见病因不同。使用垂体后叶素治疗可明显降低尿量，垂体后叶素并不能缩减多尿病程，但有利于控制尿量及维持内稳态平衡。Objective Idiopathic polyuria is a kind of common complications in ICU, currently the literatures in abroad lack studies on this disease. To explore the clinical and treatment characteristics of sudden polyuria of critical patients with multiple organ dysfunction syndrome （MODS） in the recovery stage. Methods The clinical data of burst polyuria patients in 1CU of Nanjing Gen- eral Hospital of Nanjing Military Command from January 2006 to June 2013 were retrospectively analyzed. Results A total of 15 pa-tients were enrolled in the study. The APACHE Ⅱ score was 24.3 ± 5.7 on the first day in ICU, and 16.1 ± 5.5 on the first day of polyuria. The polyuria appeared on the 3rd to 14th day after the MODS was improved and the duration of polyuria was 18.3 ± 9.6 days. The urine volume reached the peak of （81 ± 17 ）mL/（ kg . d）. The serum creatinine was （101 ± 22）μmol/L, serum potassium was （2.7 ± 0.4）μmol/L, and the urine was hypotonic during the polyuria onset. The urine volume, which was （0.74 ±0.33 ）U/h, was significantly reduced in 6 cases treated with Pituitrin. All the 15 cases were cured. Conclusion Polyuria of critical patients in the recovery phase of severe stress of MODS were different from polyuria resulted by other causes like ＂diabetes insipidus＂ , ＂ARF polyuria period＂. The urine volume can be significantly reduced when the hypophysin was used. Pituitrin is conducive to control urine volume and maintain homeostasis although it cannot reduce the course of urine diseases.

关 键 词：重症 多器官功能障碍综合征 恢复期 多尿 抗利尿激素 

分 类 号：R694.52[医药卫生—泌尿科学]