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。

Usage of torasemide in perioperative management of renal transplantation

AIM:To evaluate the utilization of torasemide in the preioperation of renal transplantation patients through comparing with the diuretic effects of furosemide.METHODS:Fifty-two renal transplantation patients were divided equally into two groups randomly.Twenty-six patients (M16,F10,age (31±s 10) a) in the torasemide group were given individually torasemide intravenously during perioperative treatment while another twenty-six patients (M15,F11,age (29±9) a) in the furosemide group were given furosemide under the same way,with a course of seven days respectively.The contents of urine potassium,urine sodium and serum potassium,serum sodium,together with blood pressure,serum creatinine and 24 h urinary volume before and after the treatment were observed.The whole blood valley value concentration of ciclosporin was monitored in two groups respectively.RESULTS:After operation,there were no significant differences shown in the two groups with the contents of sodium in the urine,sodium in the serum and serum creatinine (P>0.05). Comparing with those of furosemide group,the increased contents of the potassium in the serum and 24 h urinary volume of torasemide group were conspicuously higher (P<0.01).Comparing with that of torasemide group,the increased potassium in the urine of furosemide group was obviously higher (P<0.01).There were no significant differences with blood pressure and the blood valley value concentration of CSA in the two groups (P>0.05).The adverse reaction rates of torasemide and furosemide were 8% (2/26) and 69% (18/26) respectively,with significant differences (P<0.01).CONCLUSION:Comparing with furosemide,torasemide has the effects of both excreting sodium and preserving potassium,with no impact to the blood valley value concentration of CSA and increase of the 24 h urinary volume;outcoming with less adverse reactions,and more suitable for the perioperative renotransplantation management.