提升血浆晶体渗透压治疗儿童肾病综合征重度水肿的疗效

Efficacy of treating nephrotic syndrome children with severe edema by elevating plasma crystal osmotic pressure

目的探讨提升血浆晶体渗透压治疗儿童肾病综合征重度水肿的疗效。方法肾病综合征重度水肿患儿106例,在常规治疗基础上均加用呋塞米静脉注射和口服氢氯噻嗪及安体舒通,不限盐饮食。随机分为两组,分别采用0.9%氯化钠溶液为用药溶媒(A组,60例)和5%葡萄糖液为用药溶媒(C组,46例)。检测治疗前后相关指标变化,比较治疗后水肿消退时间和尿蛋白转阴时间,记录并发症发生情况。结果治疗后第3、7天,A组血、尿渗透压、血钠、血氯及尿量均高于C组(P<0.05或P<0.01);治疗后第10天,A组尿量多于C组(P<0.05)。A组治疗后水肿消退时间及尿蛋白转阴时间均短于C组(P<0.05)。治疗后,A组电解质紊乱5例;C组电解质紊乱16例,且肾功能不全2例,低血容量2例。A组治疗总有效率为96.7%,高于C组的52.2%(P<0.01)。结论肾病综合征患儿无需限制钠盐,补充0.9%氯化钠溶液同时加用利尿剂治疗儿童肾病综合征重度水肿疗效确定,并发症少。

Objective To explore the efficacy of treating nephrotic syndrome children with severe edema by elevating plasma crystal osmotic pressure.Methods On the basis of routine treatments,106 children with nephrotic syndrome accompanied by severe edema were treated with intravenously furosemide,orally hydrochlorothiazide and antisterone,who were randomly assigned into two groups of A（taking 0.9% sodium chloride solution as the solvent for drug administration,60cases）and B（taking 5% glucose solution as the solvent,46cases）.Salt diet was not limited.The relavent indicators were detected before and after treatment.The times for edema disappearing and urine protein turning to negative were recorded.The complications were observed.Results On the 3rd and 7th day after treatment,the osmotic pressures of blood and urine,serum levels of sodium and chlorides and urine volume were higher in group A than those in group C（P〈0.05 or P〈0.01）.The urine volume was more in group A than that in group C on the 10^（th） day after treatment（P〈0.05）.The times for edema disappearing and urineprotein turning negative after treatment in group A were shorter than those in group C（P〈0.05）.After treatment,5cases in group A had disturbance of electrolytes.There were 16 cases with electrolyte disturbance,2cases with renal insufficiency and2 cases with low blood volume in group C after treatment.Overall effectiveness rate of group A was higher than that of group C（96.7% vs.52.2%）（P〈0.01）.Conclusion There is no need to restrict sodium intake in children with nephrotic syndrome.Combined use of diuretic drugs and supplementation of 0.9% sodium chloride is helpful in treating nephrotic syndrome children with severe edema with fewer complications.