肾病综合征患者使用托拉塞米恒速泵持续静脉滴注与静脉注射的利尿效果比较  

Diuretic efficacy of torasemide in nephrotic syndrome： bolus injection versus continuous infusion

作　　者：李静[1] 谢剑腾 王曦培[2] 王慧珍[1] 左洋洋 李盛[2] 剧孟磊 付蕾[2] 文枫[2] 史伟[2] 王文健[2] 

机构地区：[1]南方医科大学研究生学院,广州510515 [2]广东省人民医院肾内科

出　　处：《中华肾脏病杂志》2017年第2期81-85,共5页Chinese Journal of Nephrology

基　　金：国家自然科学基金（81270816）

摘　　要：目的比较相同剂量托拉塞米在肾病综合征（NS）患者中分别恒速输液泵静脉滴注2h和静脉注射的疗效，探索托拉塞米治疗Ns水肿的合理用药模式。方法采用2~2自身交叉对照方案，23例住院患者入组并完成了同一剂量托拉塞米的上述两个模式的治疗，洗脱期为48h。结果与静脉注射比较，2h恒速滴注的患者24h尿量、尿氯、尿钠、24h尿钠排泄分数显著升高，尿结合态托拉塞米显著减少，尿量与托拉塞米排泄总量比值显著升高，血药浓度-时间曲线的曲线下面积（AUC）增大（均P〈0．05）。结论在NS患者使用托拉塞米治疗水肿，与常规的静脉注射比较，采用恒速泵延长输液时间至2h，可获得更好的利尿效率。Objective To compare the diuretic efficacy of torasemide as a 2-hour continuous infusion and as a bolus injection of equal dose in patients with nephrotic syndrome, and to investigate a preferable administration mode of torasemide for these patients. Methods Twenty-three hospitalized patients were randomized to receive torasemide 20 mg or 40 mg per day by either 2-hour intravenous infusion or bolus injection, and interchanged after 48 hours of washout. Results Patients received torasemide by 2-hour intravenous infusion exhibited significantly higher daily urinary volume, chloride excretion, sodium excretion and fractional excretion of sodium （FENa） within 24 hours than those by bolus injection （P 〈 0.05）. Significantly lower bound-state torasemide excretion, higher ratio of urinary volume to torasemide excretion and a markedly larger area under the curve in the plasma concentration-time profiles were also observed in the infusion group （P 〈 0.05）. Condusion 2-hour continuous infusion delivers a better diuretic effect compared with a bolus injection of equal dose of torasemide in patients with nephrotic syndrome.

关 键 词：肾病综合征 利尿药 水肿 托拉塞米 水肿 白蛋白尿 

分 类 号：R692[医药卫生—泌尿科学]