Morgan R J, Martyn J A, Philbin D M, Coggins C H, Burke J F
J Trauma. 1980 Jun;20(6):468-72. doi: 10.1097/00005373-198006000-00006.
ADH has been implicated in the development of a positive water balance in thermal injury. However, the association of plasma ADH levels to the hemodynamic response and water and electrolyte balance of early thermal injury has not been defined. Plasma ADH was measured by radioimmunoassay in 13 patients with greater than 15% body surface area burns. In three patients frequent hemodynamic measurements were also made. Large individual variations of ADH were noted, but in general the ADH levels peaked early in the postburn period and declined thereafter. The highest mean ADH value was on day 2 (53.8 = 27 pg/ml); the lowest value on day 7 (13.4 +/- 8 pg/ml). Urine electrolytes demonstrated wide variation (Na+, 2 to 236 mEq/L; K+, 2 to 228 mEq/L) as did serum (261--331 mOsm/kg) and urine (557--785 mOsm/kg) osmolalities. No correlation was noted between ADH levels and osmolalities or hemodynamic variables. These data suggest that ADH response following burns is a stress response producing levels beyond the physiologic range for an antidiuretic effect and that the osmolar, hypovolemic, and hypotensive feedback loops are not involved: ADH seems to act as a vasoconstrictor and to have no significant effect on quality or quantity of urine. We conclude that the positive water balance following burns is not ADH mediated.
抗利尿激素（ADH）与热损伤时水正平衡的发生有关。然而，血浆ADH水平与早期热损伤时血液动力学反应及水和电解质平衡之间的关系尚未明确。采用放射免疫分析法对13例烧伤面积超过15%体表面积的患者测定血浆ADH。对其中3例患者还频繁进行血液动力学测量。观察到ADH存在较大个体差异，但总体上ADH水平在烧伤后早期达到峰值，随后下降。最高平均ADH值出现在第2天（53.8±27 pg/ml）；最低值出现在第7天（13.4±8 pg/ml）。尿电解质显示出广泛变化（Na+，2～236 mEq/L；K+，2～228 mEq/L），血清（261～331 mOsm/kg）和尿（557～785 mOsm/kg）渗透压亦是如此。未观察到ADH水平与渗透压或血液动力学变量之间存在相关性。这些数据表明，烧伤后ADH反应是一种应激反应，其产生的水平超出了抗利尿作用的生理范围，且渗透压、低血容量和低血压反馈环路未参与其中：ADH似乎起血管收缩剂的作用，对尿液的质量或数量无显著影响。我们得出结论，烧伤后的水正平衡并非由ADH介导。
