托拉塞米与呋塞米对急性脑出血患者脑水肿影响的对比研究

目的对比研究托拉塞米和呋塞米联合20%甘露醇治疗急性脑出血患者脑水肿的疗效。方法选择自发性脑出血患者86例,随机分为观察组42例,对照组44例,分别使用托拉塞米和等剂量的呋塞米联合20%甘露醇进行脱水治疗,疗程为14 d。于第1、3、7、14天对2组患者行头颅CT检查,计算颅内血肿和脑水肿体积;采用无创脑水肿动态监护仪监测2组患者各时间段的综合扰动系数;同时检测患者血浆神经肽Y浓度;比较2组患者不良反应发生情况。结果观察组第3、7、14天周围脑水肿体积,患侧综合扰动系数和血浆神经肽Y浓度明显小于对照组,差异有统计学意义(P<0.05)。观察组24 h尿量明显多于对照组,差异有统计学意义[(3688.6±269.5)ml vs(3072.8±210.4)ml,P<0.05],24 h 20%甘露醇用量明显少于对照组,差异有统计学意义[(360.5±21.3)mlvs(440.2±26.3)ml,P<0.05]。结论托拉塞米在治疗急性自发性脑出血患者脑水肿方面较之呋塞米,疗效确切,不良反应少。

Effect of torasemide and furosemide on brain edema in patients with acute cerebral hemorrhage

Objective To compare the therapeutic effect of torasemide and furosemide in combination with 20%mannitol on brain edema in patients with acute cerebral hemorrhage.Methods Eighty-six patients with spontaneous cerebral hemorrhage were randomly divided into observation group(n = 42) and control group(n = 44).The patients underwent dehydration therapy with a same dose of torasemide and furosemide in combination with 20%mannitol for 14 d and head CT on days 1,3,7,and 14 with the volume of intracranial hematoma and cerebral edema calculated. General disturbance coefficient of the two groups was monitored with a non-invasive cerebral edema dynamic monitor at different time points.Level of venous plasma neuropeptide Y was measured in the patients.Incidence of adverse reactions was compared between the two groups.Results The cerebral edema volume,general disturbance coefficient and plasma neuropeptide Y level were significantly lower,and the 24 h urine volume was significantly higher while the amount of 24 h 20%mannitol was significantly lower in observation group than in control group on days 3,7,and 14(3688.6±269.5 ml vs 3072.8±210.4 ml,360.5±21.3 ml vs 440.2±26.3 ml,P<0.05).Conclusion The effect of torasemide is better than that of furosemide on cerebral edema in patients with acute intracerebral hemorrhage with a definite therapeutic effect and fewer adverse reactions.