垂体后叶素在治疗急性白血病化疗后并发咯血患者 - 内科急危重症杂志.doc

垂体后叶素致白血病患者1例并文献复习 柴海霞1 刘瑜1 万楚成1 夏云金1 1.十堰市太和医院（湖北医药学院附属医院） 湖北 十堰 442000 摘要 目的：使用垂体后叶素后临床诊治过程，探讨其可能发生机制，总结诊治经验。 方法：分析整理1例急性白血病患者并大咯血使用垂体后叶素后临床诊治资料，并相关文献进行。 结果：男，急性早幼粒细胞白血病，结束化疗后第6天发热、咯血使用垂体后叶素治疗6天，停用垂体后叶素72小时后，构音障碍、肢体活动障碍、精神行为异常行头颅MRI提示基底节区病变，经强龙冲击治疗，症状明显好转，语言功能、肢体功能及精神恢复正常水平，院外随访正常3月后复查MRI未见病灶。 结论：持续使用垂体后叶素可致脑动脉血管痉挛，诱发严重低钠血症；纠正血钠过程，可能会发生桥脑区尤其是基底节区脱髓鞘，甲强龙冲击治疗可能有效。 关键词： 垂体后叶素；低钠血症；；脱髓鞘ituitrin-induced delayed encephalopathy: one case report and literature analysis Li Zhang-Zhi1 Xu Cui1 Cai Hai-Xia1 Liu Yu1 Wan chu-cheng1 Xia yun-jin1 1.Taihe Hospital (Hubei University of Medicine) Hu bei Shi yan 442000 Abstract Objective: Reported one case of leukemia patient occurred pituitrin-related delayed encephalopathy after use of pituitrin treatment of hemoptysis，to explore the mechanism, Summarize the experience of diagnosis and treatmentMethods: Analysis the clincal data of one case with acute leukemia patients who was occurred hemoptysis after chemotherapy in our department., and Iiteratures were reviewed． Results: 20-year-old male patient with acute promyelocytic leukemia complete remission，six days after consolidation chemotherapy, was occurred fever and hemoptysis. We pumped pituitrin until the cessation of hemoptysis .About 72 hours after pituitrin, the patient burst dysarthria, limb movement disorder, mental and behavioral abnormalities. MRI showed bilateral basal ganglia lesions. Given methylprednisolone pulse therapy, the patient eventually was cured. Conclusions: After continued use of vasopressin can cause cerebral artery vasospasm, induce severe hyponatremia. Correct hyponatremia sodium process may occur pons region, especially basal ganglia demyelination, resulting in delayed encephalopathy methylprednisolone pulse therapy may be effective of pituitrin-related delayed encephalopathy. Key Words: Pituitrin Hyponatremia Delayed encephalopathy Demyelination 急性白血病患者在治疗期间容易出现严重贫血、血小板减少及重症感染，部分患者可并发咯血、消化道大出血，静脉泵入垂体后叶素、输注血小板等治疗是首选。垂体后叶素较常见副作用如血