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目的通过对抗利尿激素不适当分泌综合征(SIADH)临床特点总结分析及对托伐普坦治疗SIADH临床疗效观察,分享治疗体会,提高对该疾病诊治水平,减少漏诊及误诊率。方法回顾分析2011年10月至2013年4月我院收治的18例SIADH患者临床表现、化验结果及治疗预后情况,结合国内外文献进行讨论。结果 18例确诊SIADH患者中,94%为恶性肿瘤患者,其中28%为小细胞肺癌。不同病因患者临床表现及实验室指标无明显差异。但年龄小于65岁者显示出诊断时血钠水平更低趋势。15例患者通过限水、利尿,血钠恢复正常。2例小细胞肺癌及1例继发性肺结核患者上述治疗无效,予以托伐普坦15mg qd治疗,48h后血钠恢复正常。结论 SIADH其临床表现无特异性,早诊断、早治疗是提高救治成功率的关键。当限水、利尿仍不能纠正低钠血症时,口服托伐普坦治疗安全有效。
Objective To summarize the clinical features of SIADH and to observe the clinical effect of SIADH on the treatment of SIADH. To share the experience of treatment, improve the diagnosis and treatment of SIADH, and reduce the misdiagnosis and missed diagnosis. Methods The clinical manifestations, laboratory findings and prognosis of 18 patients with SIADH who were treated in our hospital from October 2011 to April 2013 were retrospectively analyzed, and discussed in the literature both at home and abroad. Results Of the 18 patients diagnosed with SIADH, 94% were malignant tumors, of which 28% were small cell lung cancer. Clinical manifestations of patients with different causes and laboratory indicators no significant difference. However, those younger than 65 years showed a trend toward lower serum sodium levels at diagnosis. 15 patients through water, diuretic, serum sodium returned to normal. 2 cases of small cell lung cancer and 1 case of patients with secondary tuberculosis ineffective treatment, to be treated with tolvaptan 15mg qd, serum sodium returned to normal after 48h. Conclusion The clinical manifestations of SIADH are non-specific. Early diagnosis and early treatment are the keys to improve the success rate of treatment. When limiting water, diuretic still can not correct hyponatremia, oral tollipan treatment is safe and effective.