Diagnosis and management of the syndrome of inappropriate secretion of antidiuretic hormone after thoracotomy

WU Qingchen; et al

doi:10.13406/j.cnki.cyxb.2004.04.046

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Diagnosis and management of the syndrome of inappropriate secretion of antidiuretic hormone after thoracotomy

更新时间：2024-01-17

- Diagnosis and management of the syndrome of inappropriate secretion of antidiuretic hormone after thoracotomy
- Journal of Chongqing Medical University Issue 4, Pages: 544-545(2004)
- 作者机构：
  
  1. 重庆医科大学临床学院胸心外科
  2. 重庆医科大学临床学院胸心外科,重庆,400016
- 作者简介：
- 基金信息：
- DOI：10.13406/j.cnki.cyxb.2004.04.046
  CLC： R655
- Published：2004，
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[1]吴庆琛,李强,葛明建,陈力.开胸手术后抗利尿激素分泌失调综合征的诊断和处理[J].重庆医科大学学报,2004(04):544-545+554.

WU Qingchen, et al. Diagnosis and management of the syndrome of inappropriate secretion of antidiuretic hormone after thoracotomy. [J]. Journal of Chongqing Medical University (4):544-545(2004)
[1]吴庆琛,李强,葛明建,陈力.开胸手术后抗利尿激素分泌失调综合征的诊断和处理[J].重庆医科大学学报,2004(04):544-545+554. DOI： 10.13406/j.cnki.cyxb.2004.04.046.

WU Qingchen, et al. Diagnosis and management of the syndrome of inappropriate secretion of antidiuretic hormone after thoracotomy. [J]. Journal of Chongqing Medical University (4):544-545(2004) DOI： 10.13406/j.cnki.cyxb.2004.04.046.

摘要

目的 :探讨开胸手术后抗利尿激素分泌失调综合征（syndromeofinappropriatesecretionofantidiuretichormone

SIADH）诊断和处理的一些相关问题。方法 :对 3例开胸手术（1例食管癌根治手术

1例贲门癌根治手术

1例右上肺叶切除术）后发生SIADH的临床资料进行回顾性分析。结果 :3例患者均为男性

平均年龄 71.4岁（6 7.5～ 74岁） ;在开胸手术后第3～ 4天

不明原因出现精神症状（谵妄状态）

血钠 12 5～ 12 6mmol/L、尿钠 74 .9～ 10 1mmol/L、血浆渗透压 2 5 5～ 2 80mosm/kgH2 O及尿渗透压 5 4 0～ 6 95mosm/kgH2 O ;限水 80 0～ 10 0 0ml/ 2 4h 4～ 6天内血、尿钠及血、尿渗透压恢复正常

精神症状消失。结论 :本组开胸手术后发生SIADH均为老年人

常在术后第 3～ 4天左右以不明原因的精神症状为首发症状

根据血、尿钠及血、尿渗透压等可以明确诊断

通过以限水为主的治疗后可在 4～ 6天内治愈。SIADH原因可能与大型手术后应用呼吸机正压辅助呼吸、强烈精神刺激、剧烈疼痛及应激反应使ADH分泌增多有关

Abstract

Objective:To explore the diagnosis and management of the syndrome of inappropriate secretion of antidiuretic hormone （SIADH） after thoracotomy.Methods:The clinical data of three patients with SIADH after thoracotomy （1 radical operation of esophageal carcinoma

1 radical operation of cardia carcinoma

1 pulmonary lobectomy） were analyzed retrospectively.Results:All 3 patients were males with an average age of 71.4（67.5～74）years.Psychiatric symptoms （the state of delirium） were manifestated by all patients during 3rd to 4th day after thoracotomy

and meanwhile their serum sodium decreased significantly（125～126mmol/L）;urine sodium increased abnormally（74.9～101 mmol/L）;plasma osmolality decreased（255～280mosm/kg H

O） and osmolality of urine rised（540～695mosm/kg H

O）.The psychiatric symptoms of 3 patients disappeared and their serum sodium

urine sodium

plasma osmolality

osmolality of urine reversed to normal after water restriction（800～1000ml/24h） for 4 to 6 days.Conclusion:The causes of SIADH after thoracotomy may be related to positive pressure respiration

fierce mental stress

and severe pain that can cause ADH secretion.

关键词

开胸手术抗利尿激素分泌失调综合征诊断处理

Keywords

ThoracotomySIADHdiagnosisManagement

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Related Institution

Department of Radiology，The First Affiliated Hospital of Chongqing Medical University

Teaching and Research Section of Pathology，College of Basic Medical Sciences，Chongqing Medical University

Department of Traditional Chinese Medicine，Children’s Hospital，Zhejiang University School of Medicine/ National Clinical Research Center for Child Health

Department of Pediatrics，The Affiliated Hospital of Nanjing University of Chinese Medicine，The First Clinical Medical College of Nanjing University of Chinese Medicine

Department of Respiratory Medicine，Children’s Hospital，Zhejiang University School of Medicine/ National Clinical Research Center for Child Health

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