Objective To study polyuria during mechanical ventilation in patients with chronic obstructive pulmonary disease ( COPD) and its possible mechanisms. Methods The plasma and urine concentrations of cystatin C ( CyC) were measured by enzyme immunometric assay in 26 COPD patients who received mechanical ventilation at timepoints of 0 h, 24 h, 48 h, 72 h and 1 week. And plasma levels of atrial natriuretic factor ( ANF ) , antidiuretic hormone ( ADH) and aldosterone ( ALD) were detected byradioimmunoassay at the same time-point. The urine volume was recorded every day. The samples of 30 healthy volunteers were measured as control. Results Polyuria phenomenon was found in majority of patients in 24 to 72 hours after mechanical ventilation. At 0h, the concentrations of plasma CyC, urine CyC,plasma ANF, ADH and ALD were all increased significantly compared with those of the control, respectively [ ( 4. 87 ±0. 51) mg/L vs ( 1. 29 ±0. 27) mg/L, ( 0. 58 ±0. 13) mg/L vs ( 0. 07 ±0. 02) mg/L, ( 37. 02 ±4. 35) pmol /L vs ( 22. 51 ±1. 18) pmol /L, ( 8. 61 ±1. 43) pmol /L vs ( 0.94 ±0. 34) pmol /L, ( 925. 4 ±142. 7) pmol /L vs ( 297. 5 ±135. 8) pmol /L, all P lt; 0. 01] , then decreased gradually after mechanical ventilation. The levels of plasma CyC and ANF at 24 h, plasma ADH at 72 h, and urine CyC at 1 week were similar to those of the control( all P gt;0. 05) , respectively, except the level of plasma ALD was still higher by 1 week( P lt; 0. 05) . Conclusions Polyuria is not a rare phenomenon for COPD patients receiving mechanical ventilation. Polyuria is related to the readjustment and mal-adaptation of ADH and reninangiotensin-aldosterone-systems during mechanical ventilation.
We correct some misunderstandings of hypertension therapy and update the knowledge of hypertensive drugs by reviewing the progress of evidence-based research of hypertension in 2004.
目的:探讨颅脑损伤后脑耗盐综合征患者的诊断与治疗策略。方法:对我科2006~2007年收治的37例CSWS患者临床资料进行回顾性分析和总结。结果:经治疗,37例CSWS患者31例血钠恢复正常,4例死亡,无1例发生桥脑髓鞘溶解症。结论:脑耗盐综合征是颅脑损伤后患者低钠血症的最主要原因。早期明确诊断,积极稳妥补液补钠是有效治疗CSWS患者的关键。