三联利尿剂治疗持续非卧床腹膜透析患者的临床观察

Clinical observation of triple diuretic treatment for patients with continuous ambulatory peritoneal dialysis

目的探讨三联利尿剂对持续非卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)患者在体液容量、尿钠和尿钾排泄方面的影响。方法选取2019年4月至2021年4月于义乌市中心医院治疗的116例CAPD患者作为研究对象,根据患者利尿剂用药情况将其分为三联利尿剂组和单一利尿剂组,每组各58例。三联利尿剂组患者接受呋塞米100mg/d、氢氯噻嗪50mg/d和螺内酯40mg/d治疗,单一利尿剂组患者接受呋塞米100mg/d治疗。比较两组患者治疗后3个月和6个月的尿量、尿钠排泄量、尿钾排泄量、超负荷水容量和净葡萄糖暴露量变化值,记录两组患者治疗期间不良事件发生情况。结果三联利尿剂组患者治疗3个月时超负荷水容量显著低于单一利尿剂组(P=0.014);三联利尿剂组患者治疗3个月和6个月的超负荷水容量变化值、尿量变化值均显著大于单一利尿剂组(P<0.05)。两组患者治疗3个月和6个月的尿钠、尿钾排泄量变化值比较差异均无统计学意义(P>0.05)。两组患者均无严重不良事件,不良事件发生率比较差异均无统计学意义(P>0.05)。结论对接受CAPD治疗的终末期肾病患者,呋塞米、氢氯噻嗪和螺内酯三联利尿剂联合应用可增加患者的尿量,有助于更好地控制体液容量。

Objective To investigate the effects of triple diuretics on body fluid volume,urinary sodium and urinary potassium excretion in continuous ambulatory peritoneal dialysis(CAPD)patients.Methods A total of 116 patients with CAPD who were treated in Yiwu Central Hospital from April 2019 to April 2021 were selected as the research objects,and they were divided into triple diuretic group and single diuretic group according to their diuretic medica-tion,with 58 cases in each group.The triple diuretic group received furosemide 100 mg/d,hydrochlorothiazide 50mg/d,and spironolactone 40mg/d treatment,and the single diuretic group received furosemide 100 mg/d treatment.The changes in urine volume,urinary sodium excretion,urinary potassium excretion,hyperhydration and net glucose exposure were compared between the two groups at 3 and 6 months after treatment,and the incidence of adverse events during treatment was recorded.Results After 3 months of treatment,the hyperhydration intriple diuretic group was significantly lower than that in single diuretic group(P=0.014).The changes of hyperhydration and urine volume in triple diuretic group after 3 and 6 months of treatment were significantly higher than those in single diuretic group(P<0.05).There was no significant difference in urinary sodium and potassium excretion between the two groups after 3 and 6 months of treatment(P>0.05).There were no serious adverse events in two groups,and there was no statisti-cally significant difference in the incidence of adverse events(P>0.05).Conclusion For patients with end-stage renal disease treated with CAPD,furosemide,hydrochlorothiazide and spironolactone combined diuretics can increase urine volume and help to better control body fluid volume.