大剂量利尿剂对维持性血液透析患者左心功能的影响

Znfluence of large dose of diuretics in ESRD patients on maintenance hemodialysis

目的:探讨大剂量利尿剂对终末期肾病(ERSD)维持性血液透析患者心功能衰退的延缓作用。方法:将46例每日尿量300～600 ml的新进入血液透析的ESRD患者随机分成治疗组与对照组,每组23例。治疗组使用大剂量利尿剂呋塞米,80～200 mg/d,分2次口服,透析日不用。对照组不使用利尿剂。治疗期为18个月,比较两组平均尿量、平均透析超滤量、血压控制情况及左室舒张末内径(LVDd)、左室收缩末内径(LVDs)、室间隔厚度(IVST)、左室后壁厚度(LVPWT)、左室射血分数(EF)的变化情况。结果:研究结束时与研究开始前相比,治疗组尿量进一步减少,明显少于对照组(P<0.05);与对照组相比,治疗组患者达到干体重所需平均超滤量减少,平均动脉压较对照组减低;治疗组LVDd、LVDs、IVST、LVPWT均明显小于对照组,EF明显高于对照组。结论:终末期肾病维持性血液透析患者使用大剂量利尿剂对控制水钠潴留有一定作用,使血液透析患者血压更容易控制,平均所需超滤量减少,对心功能有一定的保护作用,可能在延缓心功能恶化的进展方面起一定作用。

Objective： To explore the efficacy of large dose of diuretics in protecting cardiovascular function in end-stage renal disease （ESRD） patients on maintenance hemodialysis. Methods： Forty-six ESRD patients, initiating maintenance hemodialysis with urine volume between 300-600 ml/d were randomly divided into study group and control group. The patients in study group were administered with furosemide 80-200 mg/d, excepting dialysis day, and the patients in control group were not administered any diuret- ics. The observation duration was 18 months, the mean daily urine volume, mean ultrafiltration volume in each dialysis session, blood pressure, left ventricular diastolic dimension （LVDd）, leftventricular end-systolic dimeusion （LVDs）, inter ventricular septal thicknes （IVST）, lef ventricular posteriov wall thickness （LVPWT）, ejection fraction （EF） were compared between two groups in the end of the study. Results： At the end of the study, compared to controls, the further reduction of daily urine volume in study group was significantly less, mean artery pressure was significantly lower, LVDd, LVDs, IVST, LVPWT significantly less, and EF was higher than controls. Conclusions： It is indicated that the usage of large dose diuretics was profitable in preventing water-sodium retention in ESRD patients on maintenance hemodialysis, better controlling blood pressure, reducing ultrafiltrate needed by the patients, which is effective in reduc- ing the incidence of the cardiovascular complications of the hemodialysis patients.