重症患者特发性多尿的临床与治疗特点研究

发布时间：2018-06-10 19:08

本文选题：重症 + 多器官功能障碍综合征(Multiple　；参考：《南京大学》2014年硕士论文

【摘要】：目的多尿症是ICU中的常见并发症,我们最近在重症患者中发现一种不同于既往常见病因的特殊类型的多尿,目前国内外缺少相关研究报道,本文研究重症患者在病情逐渐好转、病程进入恢复期时发生的多尿的临床与治疗特点。方法回顾分析2006年1月至2013年6月南京军区南京总医院ICU住院病程中发生多尿症的患者临床资料,排除诊断明确的药物作用、肾脏疾病、内分泌和代谢疾病、容量负荷过高等常见因素导致多尿的病例,筛选出病程进入恢复期发生特发性多尿的病例,从这种多尿的临床表现、实验室检查及治疗效果上研究这种特发性多尿的特点。结果共15例患者纳入研究,入ICU后24小时急性生理与慢性健康评分(acute physiology and chroni c health evaluation,APACHE II)评分为(24.3±5.7)分,多尿发病后24小时评分为(16.1±5.5)分；入监护后13-27天发生多尿,多尿持续时间为(22.3±9.6)d,尿量高峰时可达(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且尿比重偏低。其中6例以垂体后叶素(Pituitrin)治疗的患者尿量明显减少。15例全部治愈。结论重症患者在病情趋于稳定后出现的多尿与常见的肾衰多尿、渗透性利尿(osmotic diuresis).尿崩症(diabetes insipidus, DI)等多尿不同；使用垂体后叶素治疗特发性多尿可明显降低尿量；垂体后叶素不能缩减特发性多尿的病程,但有利于控制尿量及维持内稳态平衡。
[Abstract]:Objective Polyuria is a common complication in ICU. We have recently found a special type of polyuria in severe patients, which is different from the common etiology in the past. At present, there is no relevant research report at home and abroad. The clinical and therapeutic characteristics of polyuria in the course of convalescence. Methods from January 2006 to June 2013, the clinical data of patients with polyuria in ICU of Nanjing General Hospital of Nanjing military region were retrospectively analyzed, and the diagnosis of drug action, kidney disease, endocrine and metabolic diseases were excluded. Cases with polyuria caused by high volume load and other common factors were screened out. The characteristics of idiopathic polyuria were studied from the clinical manifestation, laboratory examination and therapeutic effect. Results A total of 15 patients were enrolled in the study. The acute physiology and chroni c health evaluation and Apache II scores were 24.3 卤5.7, 16.1 卤5.5 and 16.1 卤5.5, respectively. The duration of polyuria was 22. 3 卤9. 6 渭 mol 路L ~ (-1), the peak of urine volume was 81 卤17? M 路L 路g / d, the serum creatinine was 101 卤22 渭 mol / L, the serum potassium was 2.7 卤0. 4 渭 mol / L and the urine specific gravity was low at the time of onset of polyuria. Of the 6 patients treated with Pituitrinin, the urine volume was significantly decreased. 15 cases were cured. Conclusion the polyuria and the common renal failure polyuria, osmotic diuresis, were found in severe patients after their condition became stable. Diabetes insipidus (DI) is different from diabetes insipidus, the treatment of idiopathic polyuria with pituitrin can significantly reduce the urine volume, and the course of idiopathic polyuria can not be reduced by pituitrin, but it is helpful to control urine volume and maintain homeostasis.
【学位授予单位】：南京大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R694.5

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