袢利尿剂对终末期肾病无尿患者容量控制的疗效观察  

Efficacy of loop diuretics on the volume control of anuric patients with end-stage renal disease

作　　者：谢祖刚 谢根萍 陈龙庚 郭耿耿 石相雅 陈晓海 陈晴 陈梅梅 Xie Zugang;Xie Genping;Chen Longgeng;Guo Genggeng;Shi Xiangya;Chen Xiaohai;Chen Qing;Chen Meimei(Department of Kidney Medicine,Longyan People's Hospital,Longyan 364000,China)

机构地区：[1]福建省龙岩人民医院肾病学科,龙岩364000

出　　处：《国际泌尿系统杂志》2020年第3期411-415,共5页International Journal of Urology and Nephrology

基　　金：福建省龙岩市科技项目(2017LY56)。

摘　　要：目的为探讨袢利尿剂对终末期肾病(ESRD)维持性血液透析(MHD)无尿患者减轻容量负荷的效果。方法2016年9月至2018年8月福建省龙岩人民医院92例尿量在50~100 mL的MHD患者分成三组,对照组A(25例,不用利尿剂),实验组B(34例,使用呋塞米片60 mg/d),实验组C(33例,使用呋塞米片120 mg/d)。研究开始前三组患者基本情况:原发病、年龄、平均尿量、血压、心胸比、血浆脑型钠利尿肽(BNP)、血尿酸值等差异无统计学意义(P>0.05),平均透析间期和透析时间差异无统计学意义(P>0.05),治疗肾性贫血及骨病、高血压、控制饮食及水钠摄入等措施三组相同,观察治疗期为3个月,终点事件为死亡及尿量持续>500 mL/d×14 d,比较三组平均尿量、平均透析超滤量、血压控制情况、心胸比、BNP、血清尿酸等指标。结果无尿患者顽固性高血压患病率54.4%高于有尿患者27.5%(P<0.001)。120 mg/d呋塞米对无尿患者4周内的降压、12周内的利尿效果明显(P<0.05),但4周后降压、12周后利尿效果较差(P>0.05);60 mg/d呋塞米对无尿患者仅1周内的降压、8周内的利尿效果明显(P<0.05),其余时间效果较差(P>0.05)。使用呋塞米对无尿患者减低BNP有统计学意义(P<0.05),此结果独立于尿量的增加。120 mg/d呋塞米能降低心胸比例(P<0.05),但60 mg/d呋塞米则无效(P>0.05)。B组治疗后尿酸改变不明显(K=0.080,P>0.05),而C组治疗后血清尿酸有升高(K=2.739,P<0.05)。结论使用呋塞米对ESRD无尿患者能明显减轻容量负荷并因此减少心胸比、BNP等心衰指标数值,并随着剂量的增加能延长作用时间及效果。Objective To explore the efficacy of loop diuretics on reducing volume load in anuric patients with end-stage renal disease(ESRD),who is receiving maintenance hemodialysis(MHD).Methods From September 2016 to August 2018,Ninety-two ESRD patients,receiving MHD,with a urine volume of 50-100 mL were randomly divided into 3 groups,the control group A(25 patients,without diuretics),the study group B(34 patients,with furosemide tablets 60 mg/d)and the study group C(33 patients,with furosemide tablets 120 mg/d).The baseline data such as age,primary disease,pre-study daily urine volume,blood pressure,cardiothoracic ratio,plasma brain natriuretic peptide(BNP),and blood uric acid value were not significantly different among the three groups(P>0.05).Also,there was no significant difference in the interval and dialysis time(P>0.05).Besides diuretics,all patients in the three groups received the same integrated treatment schedule including treating renal anemia and bone diseases,anti-hypertension,controlling diet,water and salt intake.The observation duration was 3 months,and the endpoint events were death and urine output continued to be greater than 500 mL/d×14 days.The mean urine volume,mean dialysis ultrafiltration volume,blood pressure control,cardiothoracic ratio,BNP,serum uric acid and other indicators were compared among the three groups by the end of the study.Results The prevalence of refractory hypertension in anuric patients was 54.4%,higher than that in urinary patients,which was 27.5%(P<0.001).The furosemide had good antihypertensive efficacy on anuric patients in the first 4 weeks,and had good diuretic efficacy in the first 12 weeks(P<0.05).But the antihypertensive effect was poor after 4 weeks,and the diuretic effect was poor after 12 weeks(P>0.05).Sixty mg furosemide only exerts antihypertensive effect in patients with anuric within 1 week,and diuretic effect was significant within 8 weeks(P<0.05),and less effective later(P>0.05).The usage of furosemide had statistically significance in reducing BNP in anuric

关 键 词：肾病 利尿药 肾透析 无尿症 

分 类 号：R692[医药卫生—泌尿科学]