持续泵入托拉塞米与异山梨酯治疗心肾综合征的临床研究

Clinical Study on Continuous Pumping of Torasemide and Isosorbide in the Treatment of Cardiorenal Syndrome

目的探讨持续泵入托拉塞米与异山梨酯(异舒吉)对心肾综合征的治疗效果。方法将61例利尿剂抵抗病人分为常规治疗组(n=35)与联合治疗组(n=26)。常规治疗组接受心衰的规范化治疗,根据基础病因的不同酌情调整治疗方案。联合治疗组在常规治疗组基础上给予0.9%氯化钠溶液100mL+托拉塞米100mg持续静脉泵入(10mL/h)。同时0.1%异舒吉持续泵入(2mg/h^10mg/h),根据病人血流动力学参数进行调整,最长使用时间为3d。此后改为间断用药,每天至少停用8h后可再次泵入。7d为1个疗程。记录两组病人的生命体征、电解质、每日尿量,观察心肾功能的改善情况;心脏彩色多普勒测定左心室舒张末期内径(LVEDD)、左心室后壁厚度(LVPW)及左室射血分数(LVEF);测定两组血清血管紧张素Ⅱ(AngⅡ)、醛固酮(ALD)、去甲肾上腺素(NE)、血清N末端脑钠肽原(NT-proBNP)水平。结果常规治疗组总有效率为42.8%,联合治疗组总有效率为69.2%,两组比较差异有统计学意义(P<0.05)。随着治疗时间的延长,两组病人尿量逐渐增加,但联合治疗组的利尿效果更佳(P<0.01)。与常规治疗组比较,联合治疗组心率降低,LVEF提高(P<0.01),AngⅡ、ALD、NT-proBNP等神经内分泌因子水平降低(P<0.05)。结论联合治疗可迅速改善心肾功能,减少钠水潴留,纠正电解质紊乱,其作用机制可能与其利尿、扩管及拮抗神经内分泌因子相关。

Objective To explore the effect of continuous pumping of torasemide and isoket（CPTAI）on cardiorenal syndrome（CRS）.Methods Sixty-one patients with CRS were enrolled in this study.They were individed into the conventional treatment group（n =35） and the combined treatment group（n =26） according to whether using CPTAI or not.The vital signs,serum electrolyte,daily urine output and cardiorenal function were recorded.The left ventricular end-diastolic diameter（LVEDD）,left ventricular posterior wall thickness（LVPW）and left ventricular ejection fraction（LVEF） were measured by color doppler echocardiography.The levels of serum angiotensinⅡ（AngⅡ）,aldosterone（ALD）,norepinephrine（NE） and N-terminal pro brain natriuretic peptide（NT-proBNP）were measured.The readmission rate was followed up for one month.Results The total clinical effective rate was 69.2% in the combined treatment group,which was significantly higher than that in the conventional treatment group（42.8%,Pearson χ^2=4.178 7,P〈0.05）.After treatment,the urine output was increased significantly in two groups.The diuretic effect was better in the combined treatment group.Compared with the conventional treatment group,the heart rate and the levels of serum AngⅡ,ALD,NT-proBNP were decreased while LVEF was increased in the combined treatment group（P〈0.01）.Conclusion CPTAI can quickly improve cardiorenal function,attenuate water and sodium retention and electrolyte disorder,which may be related to the diuresis,vasodilation effect and neuroendocrine factors inhibition.