托拉塞米治疗急性心力衰竭疗效及安全性的研究

Torasemide Efficacy and Safety Studies in theTreatment of Acute Heart Failure

目的:探讨托拉塞米及呋塞米在急性心力衰竭患者治疗中的有效性及安全性。方法:106例急性心力衰竭患者,根据利尿剂选择分为A组(托拉塞米组,55例)及B组(呋塞米组,51例);根据肾小球滤过率(GFR:>50ml/min,<50ml/min),A组分为A1、A2组,B组分为B1、B2组,各组治疗过程中监测血压、24h尿量、电解质、肌酐、B型尿钠肽(BNP)及心功能变化。结果:A组与B组两组间平均治疗时间分别为(3.0±0.75)d、(3.75±0.5)d;平均用药剂量为(40±10.5)mg/d、(90±15.0)mg/d。A1、B1组患者中,有效率A组与B组间差异无统计学意义(P>0.05);24h尿量A组高于B组,差异无统计学意义(P>0.05)。A2、B2组患者中,有效率A组大于B组(P<0.05);24h尿量A组增加显著高于B组(P<0.05)。△BNP变化A组均大于B组(P<0.05)。A组治疗前后平均动脉压、血清钠、血清钾均轻度降低,差异无统计学意义(P>0.05);B组治疗前后平均动脉压、血清钾降低,差异有统计学意义(P<0.05),血清钠治疗前后差异无统计学意义(P>0.05)。结论:A较B改善症状更快,利尿作用更强,尤其对于GFR明显降低患者;低血压及低血钾副作用较小,△BNP可作为短期判断治疗效果的指标。

Objective： To explore torasemide and furosemide in the treatment of patients with acute heart failure,effectiveness and security.Methods：106 cases of patients with acute heart failure,according to the diuretic Select divided into group A（torasemide group,55 cases） and group B（furosemide group,51 cases）;according to the glomerular filtration rate（GFR）（＆gt; 50 ml of/ min,＆lt;50ml/min）,A group was divided into A1,A2,B group is divided into B1,B2 groups,each group therapy process monitoring of blood pressure,24h urine volume,electrolytes,creatinine,urinary B natriuretic peptide（BNP） and changes in heart function.Result：The average duration of treatment between the two groups with Group B,Group A,respectively（3.0 ± 0.75） d（3.75 ± 0.5） d;Average dose（40 ± 10.5） mg / d（90 ± 15.0） mg / d.A1,B1 group of patients,there was no significant difference（P＆gt; 0.05） of efficiency in group A and group B;24h urine volume in group A than in group B,the difference was not statistically significant（P＆gt; 0.05）.A2,B2 group of patients,the efficiency of group A than in group B（P＆lt;0.05）;24h urine volume A group increase was significantly higher than that in group B（P＆lt;0.05）.△ BNP changes in group A than in group B（P＆lt;0.05）.Group A before and after treatment,mean arterial pressure,serum sodium,serum potassium decreased slightly,the difference was not statistically significant（P＆gt; 0.05）;reduce the mean arterial blood pressure,serum potassium before and after treatment B,the difference was statistically significant（P＆lt;0.05）,serum sodium before and after treatment showed no significant difference（P＆gt; 0.05）.Conclusion：A than B improve symptoms faster and stronger diuretic effect,especially for patients with significantly reduced GFR;hypotension and hypokalemia fewer side effects,△ BNP can be used as indicators of the short-term to determine the treatment effect.