心源性肝瘀血的利尿剂使用策略

Effects of spironolactone and furosemide for treating patients with cardiogenic liver blood stasis

目的:探讨心源性肝瘀血的利尿剂使用策略。方法:选取我院2012年1月至2016年5月收治的72例心源性肝瘀血患者,随机分为对照组和实验组(n=36),其中对照组患者根据心力衰竭指南给予标准治疗(螺内酯20mgQd,呋塞米剂量根据利尿效果调整),实验组患者在标准治疗基础上增加螺内酯剂量(螺内酯与呋塞米剂量比值100:40)。治疗2w后对两组患者的临床疗效,治疗过程中的电解质、肾功能及尿量进行比较。结果:实验组总有效率(94.44%)显著高于对照组(66.67%)(P<0.05)。治疗3d后对照组血钾较实验组显著降低(P<0.05);治疗1w及2w后对照组血钠、血钾较实验组显著降低(P<0.05),血尿素氮、血肌酐较实验组显著升高(P<0.001),而实验组无明显电解质紊乱和肾功能不全;治疗期间,实验组尿量显著高于对照组(P<0.001)。结论:大剂量螺内酯联合呋塞米(螺内酯与呋塞米剂量比值100:40)治疗心源性肝瘀血的临床疗效可靠,较少发生电解质紊乱和肾功能不全,值得临床推广。

Objective:To explore effects of spironolactone and furosemide for treating patients with cardiogenic liver blood stasis.Methods: 72 patients with cardiogenic liver blood stasis were randomly divided into the control group (36 cases) and the test group (36 cases).The control group was given standard treatment according to the guidelines for heart failure which is spironolactone (20mg qd) and furosemide.The test group was given larger dose of spironolactoneon on the basis of standard treatment.The ratio of spironolactone and furosemide dose was100:40.The clinical efficacy,electrolytes,renal function and urine volume of two groups were compared.Results: The total effective rate in the test group was significantly higher than that of the control group (P<0.01).After1week and2weeks since treatment,serum sodium and potassium of the control group were significantly lower than that of the test group (P<0.05).Blood urea nitrogen and serum creatinine of the control group were significantly higher than that of the test group (P<0.001).In the test group,there was no obvious electrolyte disorder and renal dysfunction.During treatment,the urine volume of test group was significantly higher than that of control group.Conclusion: The clinical effects of a large dose of spironolactone combined with furosemide (Spironolactone and furosemide dose ratio of100:40) in treatment of cardiogenic liver blood stasis are reliable and less disturbance of electrolyte and renal insufficiency.