托拉塞米治疗婴幼儿肾病顽固性水肿的疗效评价

Clinical evaluation of torasemide treatment for infant kidney disease with refractory edema

目的对比观察托拉塞米与呋塞米治疗婴幼儿肾病综合征(简称婴幼儿肾病)中的顽固性水肿的临床疗效。方法分析婴幼儿肾病患儿52例资料,将患儿分为A组(托拉塞米组)和B组(呋塞米组),在两组口服泼尼松足量[2 mg/(kg.d)或60 mg/(m2.d)]治疗的基础上,A组27例,静脉滴注托拉塞米1～2 mg/(kg.d),B组25例静脉滴注呋塞米1～2 mg/(kg.d),两组患儿分别于治疗前、治疗后第1、4、6天检测24 h尿量,电解质的变化情况,并记录不良反应。以尿量和血钾的变化作为主要疗效指标。结果托拉塞米与呋塞米两组患儿治疗后尿量均较治疗前明显增加,水肿消退,两组治疗前后总有效率差异无统计学意义(P>0.05);但呋塞米组患儿血钾浓度明显低于托拉塞米组(P<0.05)。结论临床上对于婴幼儿肾病综合征顽固性水肿应用托拉塞米,疗效显著,耐受性好,不良反应小,引起低血钾几率较呋塞米小,同时对其他电解质、糖或脂类等代谢及肾功能无明显影响,临床使用安全有效。

Objective To evaluate clinically the efficacy of the torasemide in the treatment of nephrotic syndrome with fintractable edema（referred to the infant nephropathy）.Methods Clinical analysis of infants with kidney disease.Fifty two cases of infant kidney disease patients were divided into group A,（Torasemide group） and group B（furosemide plug m group）,on the basis of the two oral prednisone sufficient quantities [2 mg /（kg o d） or 60 mg /（m2 o d） ],A group included 27 patients,who was performed intravenous infusion of torasemide 1～2mg /（kg.d）.B group included 25 cases,who was performed intravenous infusion of furosemide 1 ～2mg /（kg.d）.The 24 h urine,electrolyte changes,and record the adverse reactions before and after treatment 1,4,6 of two groups patients were detected and analyzed.Changes in the amount of urine and serum potassium were considered as the primary efficacy endpoint.Results The urine output in the two group children with clinical use of torasemide and furosemide,increased significantly compared with before treatment.The difference of edema,total efficiency before and after treatment was not statistically significant（P〈0.05）.The serum potassium concentration of children in furosemide group is significantly lower than that of the torasemide group（P〈0.05）.Conclusion Infant nephrotic syndrome treated with torasemide,which had significantly clinical effect,well tolerated,and little adverse reactions.The rate of hypokalemia is lower than that of furosemide.The method did not have significant influence on the other electrolytes,sugar or lipid,other metabolism and renal function.The clinical use is safe and effective.