Lieh-Lai M W, Stanitski D F, Sarnaik A P, Uy H G, Rossi N F, Simpson P M, Stanitski C L
Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit 48201-2196, USA.
Crit Care Med. 1999 Mar;27(3):622-7. doi: 10.1097/00003246-199903000-00046.
a) To determine if antidiuretic hormone (ADH) is elevated in patients undergoing spinal fusion, especially in those who have clinical evidence of syndrome of inappropriate antidiuretic hormone (SIADH); b) to evaluate the relationship between ADH secretion and the secretion of atrial natriuretic peptide (ANP).
Tertiary care pediatric intensive care unit (ICU) in a university hospital.
A prospective cross-sectional, observational study with factorial design.
Thirty patients > or = 10 yrs of age undergoing spinal fusion admitted to the ICU for postoperative care.
Patients underwent anterior, posterior, or both anterior/posterior spinal fusion. Blood was collected for serial measurements of ADH, ANP and serum electrolyte levels. Heart rate, blood pressure and central venous pressure were measured.
Thirty children were studied. Nineteen had idiopathic scoliosis, nine had neuromuscular scoliosis, one had Marfan's disease, and one had congenital scoliosis. Ten (33%) children met clinical criteria of SIADH. There was no difference in duration of surgery, blood loss, volume of iv fluid administration pre- and intraoperatively, or type of scoliosis between those who developed SIADH and those who did not. Hemodynamic variables were similar in both groups. ADH levels increased in both groups immediately postoperatively and at 6 hrs after surgery, but were much more elevated in those patients with SIADH. Patients with SIADH also had significantly higher ADH levels preoperatively. In relation to serum osmolality, ADH was considerably higher in those with SIADH compared with those who did not. Although ANP values tended to be higher in the group with SIADH, this did not reach statistical significance.
SIADH occurs in a subset of children who undergo spinal fusion. The diagnosis of SIADH can be made easily using clinical parameters which are well-defined. In the face of SIADH, continued volume expansion may be harmful, and should therefore be avoided.
a）确定接受脊柱融合手术的患者，尤其是那些有抗利尿激素分泌异常综合征（SIADH）临床证据的患者，其抗利尿激素（ADH）水平是否升高；b）评估ADH分泌与心房利钠肽（ANP）分泌之间的关系。
一所大学医院的三级儿科重症监护病房（ICU）。
一项采用析因设计的前瞻性横断面观察研究。
30例年龄≥10岁、因术后护理入住ICU接受脊柱融合手术的患者。
患者接受前路、后路或前后路联合脊柱融合手术。采集血液以连续测量ADH、ANP和血清电解质水平。测量心率、血压和中心静脉压。
对30名儿童进行了研究。其中19例患有特发性脊柱侧凸，9例患有神经肌肉型脊柱侧凸，1例患有马凡综合征，1例患有先天性脊柱侧凸。10名（33%）儿童符合SIADH的临床标准。发生SIADH的患者与未发生SIADH的患者在手术时间、失血量、术前和术中静脉输液量或脊柱侧凸类型方面没有差异。两组的血流动力学变量相似。两组患者术后即刻和术后6小时ADH水平均升高，但SIADH患者升高幅度更大。SIADH患者术前ADH水平也显著更高。与血清渗透压相关，SIADH患者的ADH水平明显高于未患SIADH的患者。虽然SIADH组的ANP值往往较高，但未达到统计学意义。
SIADH发生于接受脊柱融合手术的部分儿童中。使用明确的临床参数可轻松做出SIADH的诊断。面对SIADH时，持续扩容可能有害，因此应避免。
