大剂量速尿对腹膜透析患者容量控制及残余肾功能的影响

目的观察大剂量速尿对腹膜透析患者残余肾功能和容量状态的影响。方法33例连续性不卧床腹膜透析(CAPD)患者被随机分成试验组(17例)和对照组(16例),所有患者均接受标准CAPD治疗,试验组患者口服速尿100mg,bid,对照组不用。观察9个月,定期收集有关临床资料。结果试验前两组间的主要临床指标、实验室检查结果、腹膜转运特性无显著差异。在试验的第3、6、9个月,试验组和对照组的尿量分别为(788±198)ml和(701±187)ml、(813±220)ml和(673±194)ml、(809±209)ml和(599±176)ml,两组间差异有统计学意义;但两组间肌酐清除率的下降差异无统计学意义。试验前两组的下腔静脉内径指数(IVCDI)分别为13.82±1.21和13.78±1.09,两组间差异无统计学意义;试验结束时分别为11.72±1.10和12.65±1.16,差异有统计学意义。试验前两组的左心室质量指数(LVMI)分别为115.4±27.2和115.7±29.4,差异无统计学意义;试验结束时分别为120.9±24.5和140.0±32.6,差异有统计学意义。结论大剂量速尿能使CAPD患者的尿量增加,有利于容量超负荷的控制,从而使高血压和左心肥厚等心血管并发症减轻。

Effect of high-dose furosemide on volume state and residual renal function of CAPD patients

Objective To explore the effect of high-dose of furosemide on volume state and residual renal function. Methods Thirty-three continuous ambulatory peritoneal dialysis(CAPD) patients were randomly divided into trial group(17 cases) and control group(16 cases). All patients underwent standard CAPD. Only the patients of trial group received orally 100 mg furosemide twice daily. The trial lasted for 9 months and related clinical data were collected. Results At onset of the trial, the major clinical features, laboratory measurements and peritoneal transport characteristics were matched well. In the 3rd, 6th and 9th month of the trial,the urine volumes of trial and control groups were (788±198)ml and(701±187)ml､(813±220)ml and(673±194)ml､(809±209)ml and(599±176)ml,which were significantly differecent. However there was no statistically differece in Ccr decline between two groups. Inferior vena cava diameter index(IVCDI) was not different between trial and control groups(13.82±1.21 vs 13.78±1.09, P > 0.05) at the beginning of the trial, but it was markedly smaller in trial group than that in control group(11.72±1.10 vs 12.65±1.16, P<0.05) after the trial.Left ventricular mass index(LVMI) was almost equal(115.4±27.2 vs 115.7±29.4, P > 0.05) to two groups before the trial, but when the trial finished, LVMI of the control group was significantly higher than that of trial group(140.0±32.6 vs 120.9±24.5, P < 0.05). Conclusion High-dose furosemide can increase urine volume of CAPD patients and make the overload volume be controlled easily, thus decreasing the cardiovascular complications, such as hypertension and left ventricular hypertrophy.