托拉塞米注射液治疗急性左心衰竭疗效体会

目的：探讨分析托拉塞米注射液治疗急性左心衰竭临床疗效及安全性;方法：选取68例急性左心衰竭患者随机分为观察组和对照组,在常规治疗的基础上分别给予托拉塞米注射液和呋塞米注射液治疗,比较两组临床疗效、治疗前后离子浓度、血气分析及血液流变学指标,同时观察治疗过程中的不良反应。结果：观察组临床总有效率为97.06%较对照组的73.53%显著提高,观察组治疗后Na+、K+浓度高于对照组,观察组血气分析改善优于对照组,观察组全血黏度、血浆黏度、纤维蛋白原及血小板聚集率均显著低于对照组,观察组不良反应发生率为11.76%,较对照组的30.28%显著降低,差异具有统计学意义（P＜0.05）。结论：托拉塞米注射液治疗急性左心衰竭较呋塞米注射液可提高临床疗效,改善患者的临床症状,降低不良反应发生率,提高治疗的安全性,值得在临床上推广。     

托拉塞米与呋塞米的药理和临床作用对比研究

<正>呋塞米(furosemide)是自1966年经我国药品监督管理部门批准的袢利尿剂,近年来逐渐成为一线治疗药物。2008年,在美国排列前200位的处方药中呋塞米是唯一的髓袢利尿剂,     

4种质子泵抑制药治疗十二指肠溃疡伴出血的疗效及药物经济学研究

摘 要 目的：对比奥美拉唑、泮托拉唑、兰索拉唑及埃索美拉唑四种质子泵抑制药治疗十二指肠溃疡伴出血的疗效和安全性,并进行药物经济学研究。 方法: 采用回顾性分析方法,收集90例十二指肠溃疡伴出血的患者,按使用质子泵抑制药品种的不同分为奥美拉唑组、泮托拉唑组、兰索拉唑组及埃索美拉唑组等4组。比较各组疗效及安全性,并采用药物经济学方法进行评估。结果: 4组的治疗总有效率比较,差异无统计学意义(P>0.05)。4组患者的平均止血时间、止血率,药品不良反应发生率比较,差异均无统计学意义(P>0.05)。采用最小成本分析法,泮托拉唑组治疗成本显著低于其他3组。结论:4组治疗方案的疗效和安全性基本相当,而泮托拉唑成本最低,是药物经济学最优方案。     

心血管病临床合理用药专题笔谈

3高血压的药物治疗和临床评价 现介绍临床上经常使用的七类降压药物的用药方法和注意事项： 3．1利尿剂目前临床上常用的利尿剂有噻嗪类（代表药为氯氯噻嗪）、袢利尿剂（代表药为呋塞米）及保钾利尿剂（如氨苯喋啶和螺内酯）。美国学者研究表明，在高血压病人中约有1／3的病人有基因变异，这一基因变异可以增加肾脏的潴留钠。对携带这种变异基因的高血压病人，应用小剂量利尿剂治疗，与使用其它抗高血压药物相比较，可使心肌梗死和脑卒中的危险性降低51％。     

达格列净治疗2型糖尿病的临床疗效、不良反应以及药物经济学的研究进展

对达格列净(DAPA)治疗2型糖尿病(T2DM)的临床疗效和不良反应以及药物经济学的研究进展进行总结,为临床合理用药提供依据.通过查阅近5年的文献和书籍进行综述.DAPA具有降低血糖,控制血压,减轻体重,降低心脏衰竭住院率以及延缓肾脏疾病的作用,但生殖泌尿系统的不良反应发生率较高.同时DAPA作为附加治疗具有不错的经济...     

呋塞米与托拉塞米交替应用对利尿剂抵抗的治疗效果

目的 观察呋塞米与托拉塞米交替应用对利尿剂抵抗的治疗效果。方法 回顾性分析2018年4月—2021年4月福州市第七医院收治的利尿剂抵抗的心力衰竭患者96例病历资料,根据治疗方案不同分为呋塞米组(29例)、托拉塞米组(31例)和联合组(36例)。在常规治疗基础上,呋塞米组加用呋塞米注射液治疗,托拉塞米组加用托拉塞米注射液治疗,联合组则采取呋塞米注射液与托拉塞米注射液交替应用方案,各组均连续治疗7 d。比较3组治疗效果,治疗前后心功能指标[左室射血分数(LVEF)]、相关血清指标[血清氨基末端脑钠肽前体(NT-proBNP)、血清钾、血清钠]、肾功能指标[血肌酐(SCr)、尿量]变化及不良反应。结果 治疗总有效率联合组高于托拉塞米组高于呋塞米组(χ■=11.961,P_多样本=0.003)。治疗7 d后,3组LVEF较治疗前均上升,联合组高于托拉塞米组高于呋塞米组;3组NT-proBNP、血清钾水平较治疗前均下降,且联合组水平低于呋塞米组、托拉塞米组;联合组SCr水平低于呋塞米组、托拉塞米组,治疗后3组尿量均增加,且联合组高于呋塞米组、托拉塞米组,差异均有统计学意义(P...     

兰索拉唑和泮托拉唑用于胃溃疡治疗的药物经济学评价

目的 评价用于治疗胃溃疡时兰索拉唑与泮托拉唑药物经济学价值。方法 胃溃疡患者104例,随机分为甲组（用兰索拉唑治疗）52例和乙组（用泮托拉唑治疗）52例,用药1个月后,比较两组疗效、成本、不良反应、成本-疗效等相关研究指标。结果 两组的总有效率、不良反应率及幽门螺杆菌（HP）根除率均相似,差异无统计学意义（P〉0.05）,兰索拉唑治疗组成本-效果指标为3.42,泮托拉唑治疗组成本-效果指标为2.21,差异有统计学意义（P〈0.05）。结论 在胃溃疡的治疗上,在同一疗效水平上,泮托拉唑要比兰索拉唑更经济适用,更易于被患者所接受,值得推广应用。     

托拉塞米在肾移植病人围手术期的应用

目的:通过对比托拉塞米与呋塞米的利尿作用,探讨托拉塞米在肾移植病人围手术期中的应用价值。方法:肾移植术后病人52例,分为2组。托拉塞米组26例,男性16例,女性10例,年龄(31±s 10)a,围手术期中应用托拉塞米100 mg+氯化钠注射液500 mL,iv,qd;呋塞米组26例,男性15例,女性11例,年龄(29±9)a,围手术期中应用呋塞米400 mg·d~(-1)+氯化纳注射液500 mL,iv,qd。2组均治疗7 d为一个疗程。观察手术前和术后每日尿钾、钠及血钾、钠的含量,血压、血肌酐和24 h尿量变化情况。监测2组病人环孢素全血谷值血药浓度。结果:手术后托拉塞米组24 h尿钠、血钠含量和血肌酐与呋塞米组比较,无显著差异(P>0.05)。托拉塞米组血钾的含量和24 h尿量高于呋塞米组,差异非常显著(P<0.01)。呋塞米组24 h尿钾含量高于托拉塞米组,差异非常显著(P<0.01)。2组血压和环孢素全血谷值血药浓度比较无显著差异(P>0.05)。不良反应发生率托拉塞米组8%(2/26),呋塞米组69%(18/26),差异非常显著(P<0.01)。结论:托拉塞米具有排钠又相对保钾的作用,在增加病人尿量的同时不影响环孢素全血谷值血药浓度,减少了肾移植病人不良反应的发生,是一种比呋塞米更加适合肾移植围手术期利尿药物。     

质子泵抑制剂泮托拉唑临床合理使用评价标准的建立与应用

目的使用药物利用评价(DUE)改进我国的临床药学服务工作,为加强用药合理性提供参考。方法回顾性分析在本院收集的2012年3~8月使用泮托拉唑注射剂的出院病历160份,将其设为干预前组,建立并实施DUE干预后6个月,再抽取2012年9月~2013年2月使用泮托拉唑注射剂的病例资料160份,将其设为干预后组。比较干预前组和干预后组泮托拉唑使用情况,符合标准情况,关键病程指征及药物不良反应情况。结果干预后组使用泮托拉唑注射剂符合标准率、合理使用情况、关键病程用药指征较干预前组均明显提高,具有统计学意义(P0.05);干预后组药物不良反应较干预前组明显降低,两组使用泮托拉唑7d后临床症状均明显改善,无统计学意义(P0.05)。结论 DUE能够使泮托拉唑注射剂的用药合理性得到改善。能促进临床用药的合理性。     

2014—2016年衡阳市中心医院泌尿生殖系统药物的使用情况分析

目的 对衡阳市中心医院泌尿生殖系统药物的使用情况进行分析,为临床合理用药提供参考.方法 对2014—2016年衡阳市中心医院泌尿生殖系统药物的种类、销售金额、用药频度(DDDs)、限定日费用(DDC)和排序比(B/A)等进行统计分析.结果 2014—2016年泌尿生殖系统药物的种类、销售金额、构成比和DDDs基本不变.中成药的品种数、销售金额和DDDs均排名第一;而妇科用抗感染药和灭菌药构成比最小.DDDs一直排名前10的药物有螺内酯片、盐酸坦洛新缓释片、滋肾健脑液、保妇康栓、呋塞米片、百艾洗液、非那雄胺片7个品种.呋塞米片、氢氯噻嗪片、螺内酯片各年DDC均较低,2014—2016年DDC最高的药物分别是来曲唑片和复方大红袍止血片.非那雄胺片/分散片、托拉塞米片、戊酸雌二醇片、氢氯噻嗪片、呋塞米注射液这5种药物的B/A接近于1.0.结论 衡阳市中心医院泌尿生殖系统药物的使用基本合理,中成药一直占据重要地位,临床治疗中应根据患者的具体情况合理选择药物,以提高治疗的安全性、有效性和经济性.     

Torasemide: a pharmacoeconomic review of its use in chronic heart failure.

Torasemide is a loop diuretic used for the treatment of hypertension and for oedema in chronic heart failure (CHF), renal failure and cirrhosis. The efficacy of torasemide in reducing salt and water retention in CHF has been established in double-blind comparative studies against furosemide. Torasemide has been shown to be at least as effective as furosemide in terms of total volume of urine excreted and also has a longer duration of action. The efficacy of torasemide (in terms of improved CHF symptoms and reduced pulmonary congestion, oedema and bodyweight) has been shown in randomised controlled trials and confirmed in large postmarketing studies. In addition, data from postmarketing studies have shown that patients receiving torasemide had significantly reduced hospital admission rates compared with patients receiving furosemide. Pharmacoeconomic assessments of torasemide have focused on its effect in reducing hospitalisation. Hospitalisation costs due to CHF decreased by 86% during the 11.2-month period of torasemide treatment, compared with the 6-month period prior to treatment, in a US retrospective study assessing medical and pharmacy claims data. Overall, average monthly costs for patients decreased by 56.6% after 5.1 months (from $US1,897.28 to $US823.70 per patient per month; PPPM), and by 76% after 11.2 months (from $US1,944.76 to $US470.76 PPPM) of torasemide treatment. In the furosemide group, average monthly costs for patients increased moderately from $US227.28 to $US261.18 PPPM after 12 months. Direct comparison of the torasemide and furosemide study groups was not possible because the group receiving torasemide had much higher healthcare resource use at baseline. Compared with furosemide, torasemide was associated with reduced rates of hospital admissions for CHF and/or cardiovascular causes in 3 studies, a retrospective analysis conducted in Germany, a prospective US study of patients enrolled from hospital admissions and a decision-analysis model. As a result, the direct costs of treatment for CHF or cardiovascular diseases for patients treated with torasemide were less than those with furosemide. However, in the US study, there was no statistically significant difference in hospital admissions for all causes and/or in overall direct medical costs, although the study was not powered to show this. In another US study of managed care patients with New York Heart Association (NYHA) class II or III CHF, no difference in clinical or economic outcomes was observed between patients taking torasemide or furosemide; despite the higher acquisition costs for torasemide, total costs were similar for both groups. Torasemide was found to be more cost effective than furosemide in terms of cost per patient with improved functional (NYHA) class of CHF severity in a retrospective German analysis, although this measure is not ideal. This study also evaluated indirect costs (for loss of productivity of employed patients) and resultssuggest torasemide has a favourable effect in reducing days off work compared with furosemide, although the population of employed patients in the study was very small. Torasemide has been shown to improve some measures of quality of life in 2 studies. It was associated with higher quality-of-life scores than furosemide in a 6-month study, but the differences were only significant at month 4. In another study, torasemide significantly improved fatigue, but full study details are yet to be published. CONCLUSIONS: Despite the higher acquisition cost of torasemide over furosemide, pharmacoeconomic analyses have shown that torasemide is likely to reduce overall treatment costs of CHF by reducing hospital admissions and readmissions. Torasemide has generally shown clinical and economic advantages over furosemide, although more long term data are needed to confirm these results and to further investigate effects on quality of life. There are limitations to the currently available pharmacoeconomic data, but present data support the use of torasemide as a first-line option for diuretic therapy in patients with CHF presenting with oedema and especially in those patients not achieving relief of symptoms with furosemide.     

Torasemide. A review of its pharmacological properties and therapeutic potential.

Torasemide (torsemide) is a high-ceiling loop diuretic which acts on the thick ascending limb of the loop of Henle to promote rapid and marked excretion of water, sodium and chloride. Like furosemide (frusemide), its major site of action is from the luminal side of the cell. Torasemide is at least twice as potent as furosemide on a weight-for-weight basis, produces equivalent diuresis and natriuresis at lower urinary concentrations and has a longer duration of action, allowing once-daily administration without the paradoxical antidiuresis seen with furosemide. Torasemide also appears to promote excretion of potassium and calcium to a lesser extent than furosemide. In trials of up to 48 weeks' duration in patients with mild to moderate essential hypertension, torasemide, administered as a single daily dose, has been shown to achieve adequate blood pressure control reaching steady-state within 8 to 12 weeks. Those patients not responding initially have generally responded to a doubling of the dose. Comparative trials of up to 6 months show torasemide is as effective as indapamide, hydrochlorothiazide or a combination of triamterene/hydrochlorothiazide in maintaining control of blood pressure. Torasemide has also been used successfully to treat oedematous states associated with chronic congestive heart failure, renal disease and hepatic cirrhosis. In short term trials control of blood pressure, bodyweight and residual oedema has been sustained. Torasemide appears to be a useful alternative to furosemide in these patients, providing potent and long-lasting diuresis while being relatively potassium and calcium sparing. In clinical trials to date torasemide has been well tolerated with adverse effects of a mild, transient nature reported by only small numbers of patients. Changes in biochemical parameters have been common, including decreases in plasma sodium and potassium levels and increases in plasma creatinine and uric acid levels. These changes are typical of loop diuretics. No changes were clinically significant nor were clinically relevant changes noted in glucose metabolism, cholesterol or triglyceride levels or in haematological values. Thus, torasemide is an interesting new loop diuretic with potential use in the treatment of mild to moderate essential hypertension and of oedematous states in which diuretic therapy is warranted. Preliminary studies suggest it to be as efficacious as other diuretics in common use and to have some advantage over furosemide in duration of action and in effects on potassium and calcium. However, further long term trials in larger groups of patients are needed to delineate the place of torasemide in therapy fully, both as a single agent and in combination with other currently accepted drug regimens.     

Comparative effects of torasemide and furosemide in rats with heart failure

It has been reported that torasemide but not furosemide, may block the renin-angiotensin-aldosterone system and therefore it might attenuate myocardial remodeling accompanied by left ventricular (LV) dysfunction. We therefore compared the therapeutic effects of torasemide, a long-acting loop diuretic, and furosemide, a short-acting one, on the progression of LV remodeling in a rat model of chronic heart failure (CHF) after experimental autoimmune myocarditis (EAM). CHF was elicited in Lewis rats by immunization with porcine cardiac myosin. Twenty-eight days after immunization, rats were treated for 28 days with torasemide, furosemide, or vehicle. We investigated the effects on metabolic and neurohumoral parameters, cardiac fibrosis and remodeling in EAM rats. Diuresis was increased dose dependently by both torasemide and furosemide, showed an equipotent natriuretic effect. The urinary potassium excretion was significantly increased with furosemide in comparison to torasemide. Myocardial functional parameters were significantly improved by torasemide. Conversely, these parameters did not change in rats receiving furosemide. Torasemide suppressed LV fibrosis, myocardial protein levels of transforming growth factor-beta1, collagen III, and aldosterone synthase and improved survival rate to the control level, but furosemide did not. Moreover, both pharmacological interventions significantly elevated plasma angiotensin II and decreased atrial natriuretic peptide in a dose-dependent manner. Our results demonstrate that compared with furosemide, torasemide treatment significantly improved survival rate, LV function and ameliorated the progression of cardiac remodeling in rats with CHF after EAM.     

Torasemide for the treatment of heart failure

Diuretics play an essential role in modern cardiovascular therapy, and are currently recommended for the treatment of congestive heart failure. Torasemide has been developed as a newer type of loop diuretic with a longer half-life, longer duration of action, and higher bioavailability compared to the most commonly used loop diuretic, furosemide. Torasemide also appears to have additional actions beyond the pure diuretic effect, such as anti-aldosterone effect and vasorelaxation effect. Studies have also investigated whether the superior pharmacokinetics and pharmacological activity of torasemide result in a favorable clinical outcome. Their results have indicated that, in comparison with furosemide, torasemide improves left ventricular function, reduces mortality as well as the frequency and duration of heart failure-related hospitalization, and improves quality of life, exercise tolerance and NYHA functional class in patients with congestive heart failure. Thus, torasemide appears to be a promising loop diuretic that contributes to a better management of patients with heart failure. Definitive clinical trials in a double-blind fashion are warranted.     

Torasemide (LUPRAC): a review of its pharmacological and clinical profile

Loop diuretics potently excrete water and electrolytes and therefore have been widely prescribed for the treatment of various kinds of edema for a long time. The potent diuretic action of loop diuretics, however, often causes hypokalemia, and therefore potassium sparing diuretics have also been supplied as a concomitant drug. Torasemide (LUPRAC), a novel diuretics, shows not only an effective loop diuretic action but also a potassium sparing action due to its anti-aldosteronergic effect. Torasemide also has a high bioavailability and is only slightly influenced by meals in humans. In addition, its pharmacodynamic features contribute to its stable diuretic action without any individual differences. In animal experiments, torasemide showed about a tenfold more potent diuretic action in comparison with furosemide, an authentic loop diuretic. On the one hand, the increase in the urinary potassium excretion by torasemide was relatively slight compared to the increase in urinary sodium excretion and, as a result, the urinary sodium to potassium (Na+/K+) ratio increased. The diuretic profile of torasemide was equal to that of the concomitant use of furosemide and an anti-aldosteronergic drug, spironolactone. Torasemide showed a significant efficacy and safety in comparison with furosemide in the patients with edema in both domestic and foreign clinical studies. Moreover, torasemide also showed a decreased rate of cardiac death in comparison to furosemide in patients with chronic heart failure in a large-scale clinical study (TORIC Study). The difference in cardiac death between these two diuretics has been suggested to depend on the anti-aldosteronergic effect of torasemide. In Japan, no new loop diuretics have been developed in over 10 years. Torasemide is therefore expected to be useful as an effective diuretic for diseases with edema.     

新型袢利尿剂托拉塞米治疗心衰进展

组织水肿是心衰发生、发展过程中的重要环节,袢利尿剂的应用是心衰治疗的重要组成部分.托拉塞米是一种新型的吡啶磺酰脲类袢利尿剂.近十余年的研究证实,托拉塞米在心衰的治疗方面有良好的作用:利尿作用更强、生物利用度更高、半衰期更长、作用更持久;对电解质、血糖、血脂代谢均无影响;主要在肝脏代谢.因此,对肾脏功能不全者不会产生蓄积,可以长期使用.本文就新型袢利尿剂托拉塞米治疗心衰的研究作一综述.     

Torasemide, a long-acting loop diuretic, reduces the progression of myocarditis to dilated cardiomyopathy

Torasemide is a long-acting loop diuretic that combines the effects of both furosemide and spironolactone. It has been reported that torasemide may block the renin-angiotensin-aldosterone system and therefore it might attenuate myocardial remodeling accompanied by left ventricular dysfunction. However, nothing is known about the effect of torasemide on myocardial remodeling in a rat model in which myosin-induced experimental autoimmune myocarditis might develop into dilated cardiomyopathy. Experimental autoimmune myocarditis was elicited in Lewis rats by immunization with porcine cardiac myosin. Twenty-eight days after immunization, we investigated the effects of torasemide on metabolic and neurohumoral parameters, cardiac fibrosis and remodeling in experimental autoimmune myocarditis rats. Diuresis was increased dose-dependently by torasemide; the urinary potassium and sodium excretion was significantly decreased and increased, respectively. Myocardial functional parameters measured by hemodynamic and echocardiographic studies were significantly improved by torasemide treatment in a dose-dependent manner. The area of fibrosis, myocyte size and the myocardial protein levels of transforming growth factor-beta1, collagen III, and aldosterone synthase were significantly decreased, and the sarcoplasmic reticulum Ca2+ ATPase2 protein level was significantly increased by torasemide treatment. Moreover, the plasma levels of angiotensin II and aldosterone were increased and atrial natriuretic peptide was decreased in a dose-dependent manner. Our results indicate that torasemide treatment significantly improved left ventricular function and ameliorated the progression of cardiac remodeling beyond its renal effects in rats with chronic heart failure after experimental autoimmune myocarditis.     

Renal effects of torasemide in the rat. Clearance and micropuncture studies

The effects of torasemide on renal glomerular and tubular functions were studied in rats using clearance and micropuncture techniques. A dose-response relationship of torasemide in the range of 0.2-20 mg/kg b.w. on the increase of urine volume, urinary sodium and potassium excretion was established. The effect of a dose of 0.2 mg/kg b.w. torasemide was completely abolished by preinjection of 10 mg/kg probenecid, whereas the effects of higher doses remained unchanged. Torasemide had no significant effect on glomerular filtration rate. Proximal fractional reabsorption was not influenced. A remarkable depression of fluid and electrolyte reabsorption, however, occurred in the loop of Henle after torasemide under free flow conditions, as well as in functionally isolated microperfused loops of Henle. No further inhibition of fluid and electrolyte reabsorption between the early distal convoluted tubules and the final urine could be detected. In contrast, a compensatory increase of reabsorption was observed in this part of the nephron. The activity of the tubuloglomerular feedback system was completely and reversibly blocked by torasemide. Torasemide did not differ from other typical loop diuretics with respect to the different renal actions studied here.     

托拉塞米注射剂治疗慢性充血性心衰伴水肿临床随机对照研究

目的：评价国产托拉塞米注射剂治疗慢性充血性心衰伴水肿的临床疗效与安全性。方法：采用随机对照单盲法平行试验设计,试验组采用托拉塞米注射剂,对照组采用呋塞米注射剂。共入选208例患者,可评价病例201例。观察试验组与对照组用药疗效与安全性。结果：试验组和对照组有效率分别为99.0%及96.1%;试验组与对照组用药后24小时尿量均较治疗前明显增加;试验组和对照组不良反应发生率分别为3.88%和2.88%（P〉0.05）。结论：托拉塞米注射剂治疗慢性充血性心衰伴水肿临床疗效好,使用安全、方便,有较高的临床应用价值。     

托拉塞米注射液治疗急性左心衰竭的临床分析

目的：观察分析托拉塞米注射液对急性左心衰竭的疗效及安全性。方法：将102例急性左心衰竭患者随机分为治疗组（51例）和对照组（51例）,治疗组应用托拉塞米注射液20～80mg,对照组应用呋塞米注射液20—100mg,其余治疗相同,观察两组疗效、血气分析及电解质等的变化,并记录不良反应。结果：治疗组有效率90．2％,对照组有效率86-3％,组间差异无统计学意义;治疗组和对照组治疗后氧分压提高显著,P〈0．05;治疗组较对照组钾离子变化较小,两组比较P〈0．05。结论：应用托拉塞米注射液治疗急性左心衰竭疗效显著,安全性好。