垂体后叶素致中毒性脑病12例临床研究.doc

垂体后叶素致中毒性脑病12例临床研究[摘要] 目的 总结临床使用垂体后叶素致中毒性脑病的处理及预防经验。方法 1998～2009年用大剂量垂体后叶素静滴治疗上消化道大出血、食管胃底静脉曲张破裂出血及Dieulafoy溃疡，12例发生中毒性脑病。中毒性脑病发生后，立即停用垂体后叶素，用5%GS 500mL+硝酸甘油20mg静滴舒张血管，或加快硝酸甘油滴速，对抗垂体后叶素缩血管副作用，同时补充氯化钾、高渗盐水、葡萄糖酸钙纠正电解质紊乱，速尿或20%甘露醇减轻脑水肿以及其他对症处理，监测生命体征。结果 12例均在2～72h完全恢复，神志清楚，精神正常，电解质正常，四肢活动自如，无一例遗留后遗症，无一例死亡。结论 临床使用大剂量垂体后叶素的治疗过程中，应同时使用硝酸甘油静滴舒张血管，以减少缩血管等副作用的发生。 [关键词] 垂体后叶素；中毒性脑病 [中图分类号] R595.3 [文献标识码] B [文章编号] 1673-9701（2011）36-148-02 Posterior Pituitary Hormone Induced Toxic Encephalopathy：A Clinical Analysis of 12 Cases ZHANG Jing FENG Qi PENG Lan LIU Huazhu Department of Gastroenterology，Mianyang Central Hospital in Sichuan Province，Mianyang 621000，China [Abstract] Objective To summarize the clinical experience of treatment and prevention for the posterior pituitary hormone induced toxic encephalopathy. Methods From 1998 to 2009，upper digestive tract bleeding，esophageal varices hemorrhage and Dieulafoy ulcer were treated with a large dose of posterior pituitary hormone，and 12 cases of toxic encephalopathy occurred. Then immediately stop using the posterior pituitary hormone，and used 5%GS 500mL + 20mg nitroglycerin intravenous infusion for vasodilation，or accelerated nitroglycerin dropping speed，to antagonist the vasoconstriction side effect of posterior pituitary hormone，meanwhile added potassium chloride，hypertonic saline，calcium gluconate to correct electrolyte imbalance，furosemide or 20% mannitol to reduce brain edema，and other symptomatic treatment，and monitored the vital signs. Results All of 12 cases were fully restored in 2 to 72h，and were conscious，sane，normal electrolytes，free limbs with no remaining sequelae or deaths. Conclusion During the clinical use of large doses of posterior pituitary hormone，nitroglycerin infusion should be combined for reducing the incidence of side effects such as vasoconstriction. [Key words] Posterior pituitary hormone；Toxic encephalopathy 垂体后叶素可以收缩内脏血管，降低门脉压力，是治疗上消化道大出血、食管胃底静脉曲张破裂出血及Dieulafoy溃疡的传统药物[1，2]。我科1