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

垂体后叶素致急性白血病患者发生迟发性脑病1例并文献复习 李章志1 许翠1 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：报道1例急性白血病患者在使用垂体后叶素治疗大咯血后发生迟发性脑病的临床诊治过程，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治疗后发生迟发性脑病的临床诊治资料，并对相关文献进行复习。 结果：20岁男性患者，急性早幼粒细胞白血病完全缓解后巩固化疗，结束化疗治疗后第6天出现发热、大咯血，使用垂体后叶素治疗6天，在停用垂体后叶素72小时后，出现构音障碍、肢体活动障碍、精神行为异常，行头颅MRI提示双侧基底节区病变，经甲基强的松龙冲击、营养神经等治疗，患者神经系统症状明显好转，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；纠正低钠血钠过程中，可能会发生桥脑区尤其是基底节区脱髓鞘病变，导致迟发性脑病发生；垂体后叶素诱发迟发性脑病，甲基强的松龙冲击治疗可能有效。 关键词： 垂体后叶素；低钠血症；迟发性脑病；脱髓鞘 Pituitrin-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 treatment Methods: 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 stopping 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: Pi