托拉塞米和呋塞米治疗心肾综合征疗效对比观察

The efficacy observation of torasemide and frusemide in treatment of cadiorenal syndrome

目的 比较托拉塞米和呋塞米治疗心肾综合征的疗效及安全性.方法 60例合并肾功能不全的心力衰竭患者入院肌酐水平Ⅰ级40例、Ⅱ级20例,均完全随机平均分成托拉塞米组和呋塞米组.在常规治疗基础上,托拉塞米组加用托拉塞米20 mg/d静脉注射,呋塞米组加用呋塞米40 mg/d静脉注射.给药前后测定患者血钾、血钠、血钙、肌酐水平,记录24h尿量,同时观察患者的症状、心功能变化及不良反应发生率.结果 不同入院肌酐水平（Ⅰ级和Ⅱ级）患者托拉塞米组日平均尿量均明显高于呋塞米组[（ 1685±49）rnl比（1442±38） ml,（ 1042±32） ml比（968±38）ml,P＜0.05].肌酐水平Ⅰ级患者托拉塞米组心功能好转率高于呋塞米组[75％ （15/20）比65％ （13/20）],且血钾较呋塞米组明显升高[（＋0.03±0.01） mmol/L比（-0.01 ±0.01）mmol/L,P＜0.05],托拉塞米组血肌酐波动范围明显较小（P＜0.05）.不同肌酐水平（Ⅰ级和Ⅱ级）2组水肿消退率比较差异无统计学意义（P＞0.05）,肌酐水平Ⅱ级患者心功能好转率及血钾变化2组比较差异无统计学意义（P＞0.05）.托拉塞米组不良反应发生率为6.7％ （2/30）,呋塞米组不良反应发生率为30.0％（9/30）,2组比较差异有统计学意义（P＜0.01）.结论 对心肾综合征患者,托拉塞米利尿作用及对机体内环境的稳定性明显优于呋塞米.

Objective To observe the efficacy of torasemide and frusemide in the treatment of cadiorenal syndrome.Methods Sixty heart failure patients with renal dysfunction on admission were divided into creatinine level [ （40 cases）,Ⅱ （20 cases） and were also randomly divided into torasemide group and furosemide group.Based on the conventional treatment,torasemide group were given torasemide 20 mg/d intravenously and furosemide group were given furosemide intravenous injection of 40 mg/d.Before and after the administration of drugs,the level of serum potassium,sodium,calcium,creatinine levels were determined and every 24 h urine volume were recorded.The symptoms,the changes of heart function and the incidence of adverse reactions of the two groups were observed.Results Average urine volume of different admission creatinine levels in torasemide group was significantly higher than that in the furosemide group [ （ 1685 ± 49 ）ml vs （1442 ± 38 ）ml,（1042 ± 32）ml vs （968 ± 38 ）ml,P 〈0.05 ] ; improvement rate of heart function in torasemide group with creatinine levels stage I were higher than that in the furosemide group.The serum potassium in torasemide group increased significantly than that in furosemide group [ （ ＋ 0.03 ± 0.01 ）mmol/L vs （-0.01 ± 0.01 ）mmol/L,P 〈 0.05] with a smaller blood creatinine fluctuation range （ P 〈 0.05 ）.The swelling rate had no significant differences between the two groups （ P 〉 0.05 ） ; cardiac function improvement rate and serum potassium changes in patients with creatinine level Ⅱ level had no significant differences between the two groups （P 〉0.05 ）.The incidence of adverse reactions in the torasemide group was 6.7% （2/30） and 30.0% （9/30） in the furosemide group （ P 〈 0.0l ）.Conclusion In the treatment of cadiorenal syndrome,torasemide is more effective and safe than frusemide.