利尿剂治疗肝硬化腹水疗效的部分影响因素分析

目的探讨利尿剂治疗肝硬化腹水疗效的部分影响因素。方法收集93例肝硬化腹水患者的临床相关指标,通过单因素分析和Logistic回归分析,分析临床各项指标与利尿剂治疗肝硬化腹水疗效的关系。结果在利尿剂治疗肝硬化腹水有效和无效组中,肝硬化并发症、肝功能分级、血电解质水平、尿量、血肌酐水平和腹水程度比较差异具有显著性(P<0.05);将具有显著性差异的影响因素纳入Logistic回归模型,结果显示,肝硬化腹水利尿剂治疗有效的主要预测因素为肝功能分级(P=0.006,OR=0.326)和血肌酐水平(P=0.044,OR=0.169)。结论肝功能分级和血肌酐水平是影响肝硬化腹水利尿剂疗效的重要因素。     

补钠等综合疗法治疗顽固性肝硬化腹水55例的探讨

目的　探讨补钠疗法治疗顽固性肝硬化腹水的疗效。方法　将收治的 5 5例顽固性肝硬化腹水患者作为治疗组用 3%NaCl液静脉滴注 +综合疗法治疗。对照组 30例单纯用综合疗法治疗 ,观察比较两组患者治疗后临床症状改善情况和腹水吸收情况。结果　治疗后治疗组患者的无力、食欲不振、腹胀等症状改善情况和腹水的吸收情况明显好于对照组 ;治疗组的并发症的发生率低于对照组。结论　补钠对顽固性肝硬化腹水有确切的疗效     

补钠等综合疗法治疗顽固性肝硬化腹水55例的探讨

目的 探讨补钠疗法治疗顽固性肝硬化腹水的疗效。方法 将收治的55例顽固性肝硬化腹水患者作为治疗组用3％NaCl液静脉滴注＋综合疗法治疗。对照组30例单纯用综合疗法治疗，观察比较两组患者治疗后临床症状改善情况和腹水吸收情况。结果 治疗后治疗组患者的无力、食欲不振、腹胀等症状改善情况和腹水的吸收情况明显对于对照组；治疗组的发生率低于对照组。结论 补钠对顽固性肝硬化腹水有确切的疗效。     

高渗氯化钠及利尿剂在预防TURS中的疗效分析

目的总结经尿道前列腺汽化电切术中应用利尿剂,预防TURS(电切综合症)的临床疗效。方法回顾性分析治疗TUVP治疗中、重度BPH患者40例,前列腺电切术开始时静脉滴注3%氯化钠注射液,手术进行1小时静脉注射速尿20mg。术前测血糖及血清钠,术后再次测血糖及血清钠。对比术前、术后血糖、血清钠变化幅度。结果 40例手术过程顺利,均未发生TURS,术后血糖值平均6.5mmol/L(5.0～7.48mmol/L),较术前平均升高1.8mmol/L,血清钠平均值血清钠平均值135.2mmol/L(133～137.5mmol/L),较术前平均减低1.7mmol/L。结论高渗氯化钠及利尿剂在中、重度前列腺增生电切术中,对防止TURS是一种有效的治疗方法。     

肝硬化腹水患者利尿剂治疗的临床药学监护

目的:探讨医院开展临床药学监护的方法及内容,促进合理用药.方法:以肝硬化腹水患者的利尿剂治疗监护为切人点,深入临床,在实践中总结开展药学监护的方法.结果:通过利尿剂治疗的监护,使患者得到较好的个体化治疗,为临床合理使用利尿剂提供了参考.结论:药师深入临床,与医生、护士组成医疗团队,直接面向患者提供药学技术服务,可有效地提高药物的治疗效果,减少药物不合理应用引起的不良反应,增强患者药物治疗的依从性.     

利尿剂联合应用对难治性肝硬化腹水的治疗效果分析

目的分析对难治性肝硬化腹水患者使用多种利尿剂联合治疗的临床疗效。方法将我院收治的80例肝硬化腹水患者纳入研究。使用随机方法将其分为对照组和观察组,均40例。对照组使用常规基础法治疗。干查找使用多种利尿剂联合治疗,比较临床疗效。结果观察组的治疗效果明显高于对照组,差异显著(P<0.05)。同时两组的治疗安全性差异不显著(P>0.05)。结论在对难治性肝硬化腹水患者治疗时,使用多种利尿剂联合治疗可取得明显更佳的疗效,有较高使用价值。     

80例肝硬化腹腔积液患者对利尿剂反应的临床分析

目的：探讨肝硬化腹腔积液患者对利尿剂的反应情况,以提高对肝硬化腹腔积液的认识和治疗效果。方法：回顾分析本院消化内科2002年6月～2009年6月收治的80例肝硬化腹腔积液患者的临床资料,总结患者对利尿剂的反应。结果：80例中有58例患者对利尿剂反应良好,22例患者对利尿剂的反应比较差。结论：大部分患者对利尿剂的反应比较好,对利尿剂治疗无效的顽固性腹腔积液,需要综合分析原因,在对症治疗的基础上积极治疗原发病。     

中药利水方联合利尿剂治疗肝胆湿热型肝硬化腹水的临床疗效分析

目的：探究中药利水方联合利尿剂治疗肝胆湿热型肝硬化腹水的临床疗效。方法：选取2020年5月至2022年5月楚州中医院收治的肝胆湿热型肝硬化腹水患者64例,随机分为对照组和观察组,各32例。对照组予以利尿剂治疗,观察组行中药利水方联合利尿剂治疗,两组均治疗2w。评价两组的治疗效果,比较两组治疗前、2w后患者临床及肝肾功能指标的差异性。结果：观察组治疗有效率较对照组更高(68.75%vs 90.63%,P<0.05)。2w后,观察组腹围、体质量、腹水暗区深度、ALT、AST、Cr以及BUN均低于对照组,其24h尿量、ALB均高于对照组(P<0.05)。结论：对肝胆湿热型肝硬化腹水患者行中药利水方联合利尿剂治疗,能明显改善其肝肾功能,降低腹水量,增加24h尿量,降低腹围、体质量,疗效突出。     

高渗氯化钠联合呋塞米治疗肝硬化顽固性腹水疗效观察

目的观察高渗氯化钠联合呋塞米治疗肝硬化顽固性腹水的临床疗效。方法 10%氯化钠250mL静脉点滴后用呋塞米20mg静脉注射,每天1次,连用3d。观察其治疗效果。结果腹水消退13例,减轻2例。结论高渗氯化钠联合呋塞米治疗肝硬化顽固性腹水可降低顽固性腹水,费用低、时间短,值得推广使用。     

The influence of ascites on the pharmacokinetics of piretanide in cirrhotic patients

Summary The pharmacokinetics of piretanide, a new loop diuretic, were studied in seven patients with severe liver disease before and after resolution of ascites. The time to maximum concentration was significantly prolonged by the presence of ascites. T_max after relief of ascites was similar to that seen for normal volunteers. Area under the curves, bioavailability, volumes of distribution and elimination half-lives did not change after resolution of the ascites: two patients in whom diuretic resistant ascites occurred showed similar pharmacokinetics to that of the diuretic responders. Reduced responsiveness to piretanide therapy in patients with gross ascites does not appear to be the result of decreased bioavailability.     

Effects of diuretics on plasma lipoproteins in healthy men

Summary The fasting level of plasma very low density lipoproteins (VLDL) was increased by 30 to 50% in 12 healthy male volunteers treated with daily oral doses of hydrochlorothiazide 100 mg, chlorthalidone 100 mg or furosemide 80 mg for 3 weeks in a cross-over trial. Hydrochlorothiazide and chlorthalidone, but not furosemide, caused a 10% increase in cholesterol in the low density lipoproteins (LDL), whereas triglycerides and phospholipids in this fraction remained unchanged. High density lipoproteins (HDL) were not affected by any of the diuretics. Free palmitic and oleic acid in plasma were also increased during the treatment, perhaps because of an accumulation of cyclic 35-AMP due either to the inhibitory action of diuretics on phosphodiesterase, or to secondary activation of the sympathetic nervous systems. This would activate lipolysis in fat tissue, which in turn may induce VLDL synthesis in the liver. Each of the diuretics caused a similar rise of 20 to 30% in the mean plasma uric acid, the which could not be correlated with either triglycerides or cholesterol. Plasma sodium was increased by 2% only by furosemide, whereas potassium was decreased by 15 and 19% by hydrochlorothiazide and chlorthalidone, respectively, but not by furosemide. Mean plasma creatinine rose by 3.5% on treatment with furosemide, and by 6% with the other two diuretics. Mean body weight was reduced by 1,4 to 2,0% during treatment. No change in fasting blood sugar, plasma protein level or hematocrit was found.     

腹水超滤浓缩回输联合静脉输入人血白蛋白、利尿治疗顽固性腹水疗效观察

目的:评估腹水超滤浓缩回输联合输入人血白蛋白、利尿治疗顽固性腹水的临床疗效.方法:将我院2006～2010年收治的214例乙肝肝硬化腹水病例经基础治疗3～4天效果不好的78例,随机分为三组,第一组采用传统纠正低蛋白血症、利尿内科治疗;第二组采用单纯性腹水超滤浓缩回输治疗;第三组采用腹水超滤浓缩回输联合输入人血白蛋白、利...     

肝硬化腹水与血钠关系研究

目的比较补钠与限钠对肝硬化腹水消退和预后的影响,研究肝硬化腹水与血钠关系。方法119例肝硬化患者随机分为补钠组60例、限钠组59例。补钠组低盐饮食,静脉补氯化钠（3—5）g／d;限钠组低盐饮食。治疗前、后6d和12d检测血和尿中钠、氯,观察尿量、腹水消退和临床转归情况。结果补钠组治疗后12d血钠（139．06±7．01）mmol／L、血氯（105．76±5．46）mmol／L与同组治疗前和治疗后6d比较（P〈0．05）,与限钠组治疗后12d比较（P〈0．01）,尿钠（269．04±61．23）mmol／L、尿氯（249．21±38．98）mmol／L、尿量（2445．83±609．09）ml／d,与同组治疗前和治疗后6d比较（P〈0．01）;与限钠组治疗后12d比较（P〈0．05）,补钠组腹水消退时间、肝性脑病、肝肾综合征的发生率、病死率均低于限钠组。结论肝硬化腹水适当补钠有利于腹水消退,可以改善患者的预后。     

Site and mechanism of the action of diuretics

Abstract: The mechanism of action of diuretics can be established by studying the molecular mechanism of action, the site of action within the nephron, and the relationship between the pharmacokinetics of the diuretic and its effect. The molecular mechanism of action is known for diuretic agents such as acetazolamide (carbonic anhydrase), theophylline (phosphodiesterase), digitalis glucosides (Na-K-ATPase), spironolactone (aldosterone antagonism) and dopamine (specific receptors?). The “receptor” for the clinically most important diuretics, i.e. loop diuretics, thiazides, and other potassium-sparing diuretics is, however, unknown. It appears from recent studies of the ion transport in the dilating segment that there probably is a sodium-chloride co-transport in this segment and that loop diuretics specificly inhibit the active chloride transport. The main site of diuretic action is well established for the different groups of diuretics: carbonic anhydrase inhibitors act on the proximal tubulus, loop diuretics on the diluting segment, thiazides on the cortical diluting segment/distal tubulus, and potassium-sparing agents on distal tubulus/collecting ducts. Moreover, some diuretics have additional tubular sites of action. It is also important to realize that other effects of diuretics, e.g. inhibition of the tubuloglomerular feedback mechanism or renal and extrarenal hemodynamic effects, can modify the tubular diuretic effect. Finally, the renal handling of diuretics is of importance to the diuretic effect by determining the concentration of the drug at the “receptor” sit (s). It is emphasized that knowledge of the different aspects of the mechanisms of action of diuretics is a prerequisite for rational use of diuretics, clinically as well as experimentally.     

消胀贴膏敷脐治疗肝硬化腹水的临床代谢组学研究

为分析消胀贴膏敷脐改善肝硬化腹水的生物标志物与作用机制,为其临床应用提供科学依据,将2017年11月至2018年6月于上海中医药大学附属曙光医院确诊为肝硬化腹水伴有胃肠动力障碍的住院患者分为安慰剂组(4例)和消胀贴膏组(5例),并纳入10例健康志愿者作为对照.试验获得上海中医药大学附属曙光医院伦理委员会批准(批件号:2...     

The influence of diuretics on the excretion and metabolism of doping agents - I. Mephentermine

The urinary excretion of mephentermine and its major metabolite phentermine in human volunteers was followed over a period of several days after oral administration of mephentermine. The excretion of both substances was affected by urinary pH. Maximum excretion was observed 2-4 h after administration and the total proportion of mephentermine excreted during 54 h was 57 to 83%. Based on urinary values, the biological half-life of elimination of mephentermine was 9.9 +/- 2.6 h. The ingestion of acetazolamide shortly after administration of mephentermine resulted in a decrease in excretion of both mephentermine and phentermine during one day; in some instances, the amounts of these substances in the urine were below the detection limit for a period of 3-9 h. The administration of frusemide only produced a urinary diluting effect during 2-4 h after administration.     

Pharmacokinetics of furosemide in patients with hepatic cirrhosis

Summary The pharmacokinetics of furosemide was studied in 7 patients with diagnosed liver cirrhosis and in 7 healthy subjects. Furosemide in plasma and ascitic fluid was analyzed spectrofluorometrically. After a single intravenous dose, the cirrhotic patients showed lower initial plasma concentrations of furosemide because of the larger volume of distribution. The mean half-life in cirrhotic patients was significantly greater than in healthy volunteers. The longer half-life was associated with a reduction in the serum clearance of furosemide. Ascitic fluid volume in the patients ranged from 4.6 to 7.71. There was no significant amount of furosemide in the fluid. The diuretic interchange between this fluid and plasma was slow, as peak concentrations ranged from 0.3 to 0.5 µg/ml within 3 to 5 h after bolus administration of furosemide. Diuresis and urinary sodium excretion, 5 h after furosemide injection, were similar in both groups; larger potassium excretion was found in the cirrhotic patients.     

高效液相色谱法测定大鼠血浆和肝脏匀浆中甲基莲心碱浓度

目的：建立测定大鼠血浆和肝脏匀浆中甲基莲心碱浓度的高效液相色谱法。方法：大鼠血浆和肝脏匀浆样品经乙醚萃取，进样分析。采用Hypersil BDS C18（4．0mm×250mm，5μm）柱分离。以甲醇-磷酸二氢钾缓冲液-三乙胺（71：29：0．002）为流动相，检测波长为282nm。结果：血浆中甲基莲心碱的线性范围为31．25pμg·L^-1～2．00mg·L^-1；日内和日间RSD分别为小于8.0％和5．0％，绝对回收率为77．45％～89．23％。其在肝脏匀浆中的线性范围为62．5μg·L^-1～16．0mg·L^-1，日内和日间RSD均小于3．0％，绝对回收率为73．53%～88．43％。结论：该方法符合生物样品的检测要求，可应用于大鼠血浆和肝脏匀浆中甲基莲心碱浓度的测定。