呋塞米预防甘露醇性急性肾功能衰竭的临床观察

Clinical Observation of Furosemide in Preventing Mannitol Induced Acute Renal Failure

目的 :探讨治疗重症脑水肿患者在不减低甘露醇剂量以保持疗效的前提下 ,防止甘露醇性急性肾功能衰竭 (ARF)的有效方法。方法 :选择格拉斯哥昏迷计分法 (GCS)≤ 8分的重症脑水肿患者 ,常规应用甘露醇作为主要脱水剂 ,A组 4 0例 ,在应用甘露醇的同时应用呋塞米 (速尿 ) ,剂量为2 0mg ,每 12h 1次。B组 38例 ,用甘露醇时不用速尿。监测两组患者血肌酐、尿素氮、尿常规、血电解质等 ,记录患者转归。结果 :共发生甘露醇性ARF15例 ,其中A组 2例 ,B组 13例 ,经统计学处理两组有显著性差异。两组肾功能异常者发生率均较高 ,对照无差异 ,但发展至ARF的比率B组明显高于A组 ,有显著性差异。结论

Objective: To search the effective method of preventing mannitol induced acute renal failure (ARF) in patients with critical cerebral edema on the premise of not reducing the dosage of mannitol. Methods: Mannitol was used as the routine major dehydrating agent for patients with cerebral edema with Glasgow coma scale ≤ 8. The patients were devided into 2 groups. 40 cases (group A) received furosemide(lasix) 20 mg every 12 hours when using mannitol, while another 38 cases (group B) without lasix application when using mannitol. The patients were monitored with SCr,BUN,urine routine, blood electrolyte etc, and the results were recorded. Results: Mannitol induced ARF were occurred in 15 cases in two groups, 2 cases in gruop A and 13 in gruop B. There is statistical significant difference between the two groups. Both groups showed high incidence of abnormal renal function, but patients in group B have significantly higher prevalence of developing ARF than in group A. Conclusion: Applying lasix while using mannitol is effective in preventing mannitol induced acute renal failure.