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冠状动脉旁路手术后一过性中枢性尿崩症 1 例。

A case of transient central diabetes insipidus after aorto-coronary bypass operation.

机构信息

Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea.

出版信息

J Korean Med Sci. 2012 Sep;27(9):1109-13. doi: 10.3346/jkms.2012.27.9.1109. Epub 2012 Aug 22.

Abstract

Diabetes insipidus (DI) is characterized by excessive urination and thirst. This disease results from inadequate output of antidiuretic hormone (ADH) from the pituitary gland or the absence of the normal response to ADH in the kidney. We present a case of transient central DI in a patient who underwent a cardiopulmonary bypass (CPB) for coronary artery bypass grafting (CABG). A 44-yr-old male underwent a CABG operation. An hour after the operation, the patient developed polyuria and was diagnosed with central DI. The patient responded to desmopressin and completely recovered five days after surgery. It is probable that transient cerebral ischemia resulted in the dysfunction of osmotic receptors in the hypothalamus or hypothalamus-pituitary axis during CPB. It is also possible that cardiac standstill altered the left atrial non-osmotic receptor function and suppressed ADH release. Therefore, we suggest that central DI is a possible cause of polyuria after CPB.

摘要

尿崩症(DI)的特征是排尿过多和口渴。这种疾病是由于脑下垂体分泌抗利尿激素(ADH)不足或肾脏对 ADH 无正常反应引起的。我们报告了 1 例因冠状动脉旁路移植术(CABG)行体外循环(CPB)后出现短暂性中枢性尿崩症的患者。一名 44 岁男性患者接受了 CABG 手术。术后 1 小时,患者出现多尿,被诊断为中枢性尿崩症。患者对去氨加压素反应良好,术后 5 天完全康复。CPB 期间,可能短暂性脑缺血导致下丘脑渗透压感受器或下丘脑-垂体轴功能障碍。也可能是心脏停搏改变了左心房非渗透性受体功能并抑制了 ADH 释放。因此,我们认为中枢性尿崩症是 CPB 后多尿的可能原因。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6fa8/3429832/0b9118c74d42/jkms-27-1109-g001.jpg

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