托拉塞米在重症心脏联合瓣膜置换病人围手术期中的应用

目的:通过对比托拉塞米与呋塞米的利尿作用,探讨托拉塞米在重症心脏联合瓣膜置换病人围手术期中的应用价值。方法:重症心脏联合瓣膜置换病人60例,随机分为2组。托拉塞米组30例,男性6例,女性24例,年龄(54±s 12)a,围手术期中应用托拉塞米静脉注射治疗;呋塞米组30例,男性5例,女性25例,年龄(54±12)a,围手术期中应用托拉塞米静脉注射治疗。观察用手术前及手术后1,3,7,14d,24h尿中钾、钠、肌酐的含量。结果:手术后,2组24h尿钠、钾和肌酐含量均增高,与手术前比较差异非常显著(P<0.01);手术后3d起,托拉塞米组24h尿钾、钠含量低于呋塞米组,肌酐含量高于呋塞米组,差异非常显著(P<0.01)。不良反应发生率托拉塞米组10％(3/30),呋塞米组80％(24/30),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,减少了不良反应的发生,是一种比呋塞米更加适合于重症联合心脏瓣膜置换术病人的围手术期利尿药物。     

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...     

托拉塞米对重度心力衰竭的短期临床疗效观察

目的探讨托拉塞米对重度心力衰竭的短期临床疗效及副作用。方法58例重度心力衰竭分为托拉塞米组与呋塞米组,在心衰常规治疗方法相同的情况下,比较两组对心衰患者总有效率、尿量、浮肿消退、血钾、血钠、血Cr变化。结果托拉塞米组总有效率明显优与呋塞米组（93．7％ vs 82．1％P〈0．05）存在显著性差异;尿量（2600ml vs 2100ml）,存在显著差异（P〈0．05）;浮肿消退：托拉塞米组明显消退95．8％,呋塞米组63．6％存在显著差异（P〈0．05）．在每日补钾相同情况下,托拉塞米组血钾上升0．2mmol·L^-1未发生新的低血钾,呋塞米组血钾下降0．1mmol·L^-1低血钾发生率两组存在显著差异（P〈0．05）,两组对血钠、血Cr影响无显著性差异。结论托拉塞米对重度心力衰竭患者有较好的短期疗效、利尿作用强、浮肿消退率高、副作用相对较少。     

呋塞米与托拉塞米对慢性心力衰竭的治疗有效性对比研究

目的:比较呋塞米与托拉塞米治疗慢性心力衰竭的临床效果。方法:选择某院48例慢性心力衰竭患者随机分为观察组和对照组各24例,对照组给予呋塞米治疗,观察组给予托拉塞米治疗。结果:观察组和对照组各24例,观察组总有效率为95.83%,对照组为75.00%,观察组有效率明显高于对照组(P0.05);治疗后,观察组血钠、血钾水平低于对照组,尿量高于对照组,差异均有统计学意义(P0.05);观察组不良反应发生率为0.00%,对照组为16.67%,观察组显著低于对照组(P0.05)。结论:托拉塞米治疗慢性心力衰竭起效快,不良反应小,较呋塞米有更好的治疗效果。     

托拉塞米与呋塞米治疗儿童肾病综合征伴高度水肿的疗效评价

目的:观察托拉塞米与呋塞米治疗儿童肾病综合征引起水肿的临床疗效。方法:选取54例儿童肾病综合征患儿,将54例患儿分为托拉塞米组、呋塞米加口服补钾组、呋塞米组各18例。三组患儿在激素及一般治疗的基础上,托拉塞米组给予静脉注射托拉塞米1 mg/(kg·d),每次不超过20 mg;呋塞米加口服补钾组给予静脉注射呋塞米2 mg/(kg·d),每次不超过40 mg,并口服补钾;呋塞米组给予静脉注射呋塞米2 mg/(kg·d),每次不超过40 mg。三组患儿分别于治疗前1 d、治疗后每天记录24 h尿量,治疗前及治疗后第4天抽外周血查电解质的变化情况,并记录不良反应。结果:三组患儿治疗后尿量较治疗前均显著增多,但治疗后前3 d平均尿量三组比较差异无统计学意义(P>0.05);呋塞米组治疗后第4天血钾浓度较其余两组降低明显(P<0.05);托拉塞米组和呋塞米加口服补钾组患儿治疗后第4天血钾浓度比较差异无统计学意义(P>0.05)。结论:临床上对于儿童肾病综合征引起的水肿应用托拉塞米或呋塞米治疗效果显著。应用呋塞米时同时口服补钾可减轻其致低血钾的不良反应。     

托拉塞米和呋塞米治疗心肾综合征疗效对比观察

目的 比较托拉塞米和呋塞米治疗心肾综合征的疗效及安全性.方法 60例合并肾功能不全的心力衰竭患者入院肌酐水平Ⅰ级40例、Ⅱ级20例,均完全随机平均分成托拉塞米组和呋塞米组.在常规治疗基础上,托拉塞米组加用托拉塞米20 mg/d静脉注射,呋塞米组加用呋塞米40 mg/d静脉注射.给药前后测定患者血钾、血钠、血钙、肌酐水平,记录24h尿量,同时观察患者的症状、心功能变化及不良反应发生率.结果 不同入院肌酐水平(Ⅰ级和Ⅱ级)患者托拉塞米组日平均尿量均明显高于呋塞米组[( 1685±49)rnl比(1442±38) ml,( 1042±32) ml比(968±38)ml,P＜0.05].肌酐水平Ⅰ级患者托拉塞米组心功能好转率高于呋塞米组[75％ (15/20)比65％ (13/20)],且血钾较呋塞米组明显升高[(+0.03±0.01) mmol/L比(-0.01 ±0.01)mmol/L,P＜0.05],托拉塞米组血肌酐波动范围明显较小(P＜0.05).不同肌酐水平(Ⅰ级和Ⅱ级)2组水肿消退率比较差异无统计学意义(P＞0.05),肌酐水平Ⅱ级患者心功能好转率及血钾变化2组比较差异无统计学意义(P＞0.05).托拉塞米组不良反应发生率为6.7％ (2/30),呋塞米组不良反应发生率为30.0％(9/30),2组比较差异有统计学意义(P＜0.01).结论 对心肾综合征患者,托拉塞米利尿作用及对机体内环境的稳定性明显优于呋塞米.     

托拉塞米治疗肾病顽固性水肿的疗效与安全性观察

目的：对比分析呋塞米和托拉塞米对肾病顽固性水肿尿量、血钾的影响。方法选取2013年4月～2014年4月收治的肾病顽固性水肿患者40例,并随机分为呋塞米组（20例）和托拉塞米组（20例）,两组均予常规治疗原发病[激素、血管紧张素转化酶抑制剂（ACEI）、血管紧张素Ⅱ受体阻滞剂（ARB）、尿毒清等],两组在常规使用呋塞米40～80 mg静脉推注连续5 d后,呋塞米组继续将呋塞米80～100 mg加入0.9%氯化钠溶液100 mL中静脉滴注;托拉塞米组改为托拉塞米80～100 mg加入0.9%氯化钠溶液100 mL中静脉滴注,均每日1次,连用7 d。比较两组患者治疗1、4、7天后血钾及平均尿量的变化。结果①治疗后托拉塞米组尿量较治疗前明显增加,差异具统计学意义（P＜0.05）;②托拉塞米组总有效率为85%,高于呋塞米组（70%）,差异具统计学意义（P＜0.05）;③呋塞米组治疗后血钾浓度明显低于托拉塞米组,差异具统计学意义（P＜0.05）。结论对于肾病顽固性水肿,呋塞米治疗效果不明显时可应用托拉塞米,可明显改善症状,提高治疗总有效率,减少低血钾等不良反应。     

托拉塞米与呋塞米对慢性心力衰竭治疗效果的比较

目的比较分析托拉塞米与呋塞米对慢性心力衰竭治疗效果。方法选取我院80例慢性心力衰竭患者,将其随机分为观察组和对照组,每组40例,观察组使用托拉塞米治疗,对照组使用呋塞米治疗,观察比较两组治疗前后的尿量和电解质情况,以及心功能的分级。结果观察组患者治疗后的尿量、血钠和血钾水平明显优于治疗前和对照组(P0.05),心功能明显改善。结论在治疗慢性心力衰竭中,托拉塞米的利尿效果更好,能有效纠正电解质紊乱,改善患者心功能,值得临床的广泛应用。     

托拉塞米注射液治疗儿童肾病综合征高度水肿的临床疗效观察

目的 探讨新型袢利尿剂托拉塞米注射液治疗儿童肾病综合征高度水肿的临床疗效.方法 对本科室2010年1月至2013年12月收治的肾病综合征患儿进行临床分析,将32例肾病综合征高度水肿患儿按随机数字表法分为托拉塞米组和呋塞米组,每组16例.两组在口服泼尼松足量[2 mg/（kg·d）或60 mg/（m^2·d）]治疗的基础上,托拉塞米组静脉滴注托拉塞米1～2 mg/（kg·d）,呋塞米组静脉滴注呋塞米1～2 mg/（kg·d）,疗程为5d.两组患儿分别于治疗前、治疗后第2、4、6d检测24 h尿量、体重、血液生化各项指标的变化情况,并记录不良反应.结果 托拉塞米与呋塞米两组患儿临床疗效比较,尿量均较治疗前明显增加,水肿消退,体重减轻,两组总有效率之间差异有统计学意义（94％ vs.81％; x2=3.023,P＜0.05）.呋塞米组患儿血钾浓度明显低于托拉塞米组（P＜0.05）,血尿酸明显高于托拉塞米组（P＜0.05）.结论 托拉塞米治疗儿童肾病综合征顽固性水肿,疗效显著,副作用小,对电解质及肾功能无明显影响,值得临床应用.     

瓣膜置换术后持续静脉微量注射呋塞米疗效观察

目的：观察对比瓣膜置换术后患者持续静脉微量注射呋塞米或间断注射呋塞米的疗效,及呋塞米剂量和对血脑钠肽浓度的影响。方法：126例瓣膜置换患者随机分为观察组与对照组,观察组63例持续微量注射呋塞米,对照组63例间断注射呋塞米。根据常规术后处理,保持合理尿量和血液动力学指标水平,比较两组患者平均每日呋塞米总剂量,记录术后4,12 h尿量,测定两组术前和术后第3天血脑钠肽浓度。结果：观察组呋塞米日剂量低于对照组（P〈0.05）;两组均未发生严重不良反应（P〉0.05）;两组术前术后血脑钠肽浓度差异无统计学意义（P〉0.05）;观察组术后4,12 h尿量均明显高于对照组（P〈0.05）,两组术后24 h尿量差异无统计学意义（P〉0.05）。结论：瓣膜置换术后患者持续静脉微量注射呋塞米可减少呋塞米用量,利尿效果优于间断注射呋塞米,且不影响血脑钠肽浓度,无严重并发症。     

呋塞米与托拉塞米间隔使用治疗慢性心力衰竭的临床观察

目的探讨呋塞米与托拉塞米间隔使用治疗慢性心力衰竭（CHF）的疗效。方法将符合纳入标准患者随机分成试验组和对照组。试验组先使用呋塞米片7 d,然后改为托拉塞米片7 d;对照组使用呋塞米片14 d。比较两组治疗14 d后总有效率、尿量、电解质及pro-BNP的差别。结果①试验组总有效率为89.66%,显著高于对照组（77.01%）,差异有统计学意义（χ^2=7.968,P=0.019）;②两组治疗后尿量较治疗前显著增加,差异有统计学意义（P〈0.05）,血钾和pro-BNP均较治疗前显著下降,差异有统计学意义（P〈0.05）;③治疗后试验组尿量和血钾显著高于对照组,差异有统计学意义（P〈0.05）,pro-BNP显著低于对照组,差异有统计学意义（P〈0.05）;④试验组总不良反应发生率及低钾血症发生率显著低于对照组,差异有统计学意义（P〈0.05）。结论呋塞米与托拉塞米间隔使用可提高CHF治疗的总有效率,增加尿量,减少电解质紊乱等不良反应。     

Pharmacokinetics and pharmacodynamics of intravenous trasemide in mutant Nagase analbuminemic rats

The importance of plasma protein binding of intravenous furosemide in circulating blood for its urinary excretion and hence its diuretic effects in mutant Nagase analbuminemic rats (NARs, an animal model for human familial analbuminemia) was reported. Based on the furosemide report, the diuretic effects of another loop diuretic, torasemide, could be expected in NARs if plasma protein binding of torasemide is considerable in the rats. This was proven by this study. After intravenous administration of torasemide, 10 mg/kg, to NARs, the plasma protein binding of torasemide was 23.3% in the rats due to binding to alpha- and beta-globulins (this value, 23.3%, was greater than only 12% for furosemide), and hence the percentages of intravenous dose of torasemide excreted in 8-h urine as unchanged drug was 14.9% in the rat (this value was considerably greater than only 7% for furosemide). After intravenous administration of torasemide to NARs, the AUC (301 versus 2680 microg/min/ml) was significantly smaller [due to significantly faster both Cl(r) (4.81 versus 0.386 ml/min/kg) and Cl(nr) (28.3 versus 3.33 ml/min/kg)], terminal half-life (18.3 versus 73.5 min) and mean residence time (6.97 versus 61.8 min) were significantly shorter (due to faster Cl, 33.2 versus 3.74 ml/min/kg), and amount of 8-h urinary excretion of unchanged torasemide (446 versus 323 microg, due to increase in intrinsic renal excretion) was significantly greater than those in control rats. The 8-h urine output and 8-h urinary excretions of sodium and chloride were comparable between two groups of rats although the 8-h urinary excretion of torasemide was significantly greater in NARs. This could be explained by the following. The amount of urinary excretion of torasemide was significantly greater in NARs than that in control rats only between 0 and 30 min urine collection. In both groups of rats, the urinary excretion rate of torasemide during 0-30 min reached an upper plateau with respect to urine flow rate as well urinary excretion rates of sodium and chloride. Therefore, the diuretic effects (8-h urine output and 8-h urinary excretions of sodium and chloride) were not significantly different between the two groups of rats.     

EFFECTS OF TORASEMIDE ON RENAL HAEMODYNAMICS AND FUNCTION IN ANAESTHETIZED DOGS

1. We examined the effects of torasemide (0.3 and 1 mg/kg i.v.) on renal haemodynamics and function employing renal clearance and stop-flow techniques in anaesthetized dogs and compared these with furosemide (1 and 3 mg/kg i.v.). 2. Torasemide and furosemide did not influence renal haemodynamics, in the renal clearance study, but caused a dose-related and significant increase in urine flow and urinary excretion of sodium and potassium. Torasemide and furosemide increased fractional excretion of sodium in the distal tubules with a relatively small increase in the fractional excretion of lithium (index of sodium excretion at the proximal tubules, FELi). The diuretic profile of torasemide was of long duration, compared with that of furosemide. 3. Torasemide and furosemide inhibited sodium reabsorption at the distal portion of the tubules in the stop-flow study. 4. It is suggested from these results, that the main diuretic site of action of torasemide is the ascending limb of the loop of Henlé.     

Diuretic action of the novel loop diuretic torasemide in the presence of angiotensin II or endothelin-1 in anaesthetized dogs.

The effects of torasemide (0.1 and 1 mg kg-1, i.v.) and furosemide (3 mg kg-1) on renal haemodynamics and excretory responses in the presence of angiotensin II and endothelin-1 was examined in anaesthetized dogs. Angiotensin II or endothelin-1 was continuously infused into the renal artery throughout the experiment and a bolus of torasemide or furosemide was injected into the bracheal vein. Continuous intrarenal arterial (i.r.a.) infusion of angiotensin II, at a dose of 5 ng kg-1 min-1, increased renal vascular resistance (RVR) and decreased renal blood flow (RBF) and glomerular filtration rate (GFR), but had no effect on systemic mean arterial pressure (MAP). Urinary excretion of sodium (UNaV) and urine flow (UF) were significantly decreased during angiotensin II infusion. Intravenous injections of torasemide in the presence of angiotensin II caused a dose-dependent increase in UF, UNaV and urinary excretion of potassium (UKV), while a decrease in RVR was accompanied by an increase in RBF. UKV was greater in the furosemide group than in the torasemide group, despite both groups having the same degree of aquaresis and natriuresis. Continuous i.r.a. infusion of endothelin-1, 1.5 ng kg-1 min-1, produced effects similar to those of angiotensin II on renal haemodynamics; however, the onset of action was extremely slow compared with the effects produced by angiotensin II. Endothelin-1 caused a significant decrease in UF, UNaV and UKV only at a later period, despite a relatively early depression of renal haemodynamics. Torasemide and furosemide also produced a sufficient diuretic action in this model.(ABSTRACT TRUNCATED AT 250 WORDS)     

自拟康肾口服液对水负荷大鼠模型的影响

目的研究康肾口服液对水负荷大鼠模型的影响。方法体重180～200 g Wistar大鼠,雄性,72只,随机分为6组,分别灌服康肾口服液、尿毒清颗粒混悬液、呋塞米片混悬液和同体积的生理盐水。测尿液中Na+、K+、Cl-的浓度。结果水负荷大鼠模型成功建立。与模型组比显著增加大鼠尿液量(P<0.01),可显著增加尿液中尿钠离子含量(P<0.01),可显著增加尿液中尿氯离子含量(P<0.01),可显著增加尿液中尿钾离子含量(P<0.01)。结论康肾口服液有显著的利尿作用,且优于尿毒清颗粒、呋塞米片。     

托拉塞米治疗充血性心力衰竭的疗效及安全性的临床观察

目的：观察托拉塞米治疗充血性心力衰竭的临床疗效及安全性。方法：选取30例充血性心力衰竭患者,将其随机分为托拉塞米组与呋塞米组,在心力衰竭常规治疗方法一致的情况下,分别予托拉塞米与呋塞米20mg静推,治疗7d,记录两组患者治疗前后血压、血钾浓度、BNP值及EF值。结果：两组患者血压均有下降,但组间差异无统计学意义;托拉塞米组低血钾发生率更低,BNP下降且心功能改善更明显。结论：托拉塞米可一定程度改善心功能,低血钾及血压变化等不良反应较轻。