Objective To study polyuria during mechanical ventilation in patients with chronic obstructive pulmonary disease ( COPD) and its possible mechanisms. Methods The plasma and urine concentrations of cystatin C ( CyC) were measured by enzyme immunometric assay in 26 COPD patients who received mechanical ventilation at timepoints of 0 h, 24 h, 48 h, 72 h and 1 week. And plasma levels of atrial natriuretic factor ( ANF ) , antidiuretic hormone ( ADH) and aldosterone ( ALD) were detected by
radioimmunoassay at the same time-point. The urine volume was recorded every day. The samples of 30 healthy volunteers were measured as control. Results Polyuria phenomenon was found in majority of patients in 24 to 72 hours after mechanical ventilation. At 0h, the concentrations of plasma CyC, urine CyC,plasma ANF, ADH and ALD were all increased significantly compared with those of the control, respectively [ ( 4. 87 ±0. 51) mg/L vs ( 1. 29 ±0. 27) mg/L, ( 0. 58 ±0. 13) mg/L vs ( 0. 07 ±0. 02) mg/L, ( 37. 02 ±4. 35) pmol /L vs ( 22. 51 ±1. 18) pmol /L, ( 8. 61 ±1. 43) pmol /L vs ( 0.94 ±0. 34) pmol /L, ( 925. 4 ±142. 7) pmol /L vs ( 297. 5 ±135. 8) pmol /L, all P lt; 0. 01] , then decreased gradually after mechanical ventilation. The levels of plasma CyC and ANF at 24 h, plasma ADH at 72 h, and urine CyC at 1 week were similar to those of the control( all P gt;0. 05) , respectively, except the level of plasma ALD was still higher by 1 week( P lt; 0. 05) . Conclusions Polyuria is not a rare phenomenon for COPD patients receiving mechanical ventilation. Polyuria is related to the readjustment and mal-adaptation of ADH and reninangiotensin-
aldosterone-systems during mechanical ventilation.
Citation：
ZHANG Jing,LEI Junrong,LUO Guoshi,LIU Xianjun,WU Shangjie,ZHOU Rui,TU Mingli. Polyuria in Patients with COPD During Mechanical Ventilation and Its Possible Mechanism. Chinese Journal of Respiratory and Critical Care Medicine, 2009, 09(6): 551-554. doi:
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Copyright © the editorial department of Chinese Journal of Respiratory and Critical Care Medicine of West China Medical Publisher. All rights reserved
| 1. |
陈文彬. 机械通气对生理功能的影响及并发症防治. 见: 应明英, 主编. 实用危重病监测治疗学. 北京: 人民卫生出版社,1998, 214-218.
|
| 2. |
刘春涛, 王靖, 王建峰, 等. 机械通气中的尿量问题. 中国呼吸与危重监护杂志, 2003, 2: 337-339.
|
| 3. |
中华医学会呼吸病学分会慢性阻塞性肺疾病学组. 慢性阻塞性肺疾病诊治指南. 中华内科杂志, 2002, 41: 640-646.
|
| 4. |
Tarif N, Alwakeel JS, Mitwalli AH, et al. Serum cystatin C as a marker of renal function in patients with acute renal failure. Saudi J Kidney Dis Transpl, 2008, 19: 918-923.
|
| 5. |
沈雄文, 孙关忠, 胡云华. 尿胱抑素C 检测方法的建立及初步临床应用. 国际检验医学杂志, 2007, 28: 483-485.
|
| 6. |
Farber MO, Weinberger MH, Robertson GL, et al. Hormonal abnormalities affecting sodium and water balance in acute respiratory failure due to chronic obstructive lung disease. Chest, 1984, 85 : 49 -54.
|
| 7. |
Sin DD, Wong E, Mayers I, et al. Effects of nocturnal noninvasive mechanical ventilation on heart rate variability of patients with advanced COPD. Chest, 2007, 131: 156-163.
|
| 8. |
Vesely DL, Douglass MA, Dietz JR, et al. Three peptides from the atrial natriuretic factor prohormone amino terminus lower blood pressure and produce diuresis, natriuresis, and / or kaliuresis in humans. Circulation, 1994, 90 : 1129 -1140 .
|
| 9. |
Robertson GL. Regulation of arginine vasopressin in the syndrome of inappropriate antidiuresis. Am J Med, 2006, 119: S36-S42.
|
| 10. |
Verbalis JG. Whole-body volume regulation and escape from antidiuresis. Am J Med, 2006, 119: S21-S29.
|
| 11. |
Schrier RW. Molecular mechanisms of clinical concentrating and diluting disorders. Prog Brain Res, 2008, 170: 539-550.
|
- 1. 陈文彬. 机械通气对生理功能的影响及并发症防治. 见: 应明英, 主编. 实用危重病监测治疗学. 北京: 人民卫生出版社,1998, 214-218.
- 2. 刘春涛, 王靖, 王建峰, 等. 机械通气中的尿量问题. 中国呼吸与危重监护杂志, 2003, 2: 337-339.
- 3. 中华医学会呼吸病学分会慢性阻塞性肺疾病学组. 慢性阻塞性肺疾病诊治指南. 中华内科杂志, 2002, 41: 640-646.
- 4. Tarif N, Alwakeel JS, Mitwalli AH, et al. Serum cystatin C as a marker of renal function in patients with acute renal failure. Saudi J Kidney Dis Transpl, 2008, 19: 918-923.
- 5. 沈雄文, 孙关忠, 胡云华. 尿胱抑素C 检测方法的建立及初步临床应用. 国际检验医学杂志, 2007, 28: 483-485.
- 6. Farber MO, Weinberger MH, Robertson GL, et al. Hormonal abnormalities affecting sodium and water balance in acute respiratory failure due to chronic obstructive lung disease. Chest, 1984, 85 : 49 -54.
- 7. Sin DD, Wong E, Mayers I, et al. Effects of nocturnal noninvasive mechanical ventilation on heart rate variability of patients with advanced COPD. Chest, 2007, 131: 156-163.
- 8. Vesely DL, Douglass MA, Dietz JR, et al. Three peptides from the atrial natriuretic factor prohormone amino terminus lower blood pressure and produce diuresis, natriuresis, and / or kaliuresis in humans. Circulation, 1994, 90 : 1129 -1140 .
- 9. Robertson GL. Regulation of arginine vasopressin in the syndrome of inappropriate antidiuresis. Am J Med, 2006, 119: S36-S42.
- 10. Verbalis JG. Whole-body volume regulation and escape from antidiuresis. Am J Med, 2006, 119: S21-S29.
- 11. Schrier RW. Molecular mechanisms of clinical concentrating and diluting disorders. Prog Brain Res, 2008, 170: 539-550.
