托拉塞米与呋塞米对急性心力衰竭患者尿量及电解质影响比较

目的比较托拉塞米与呋塞米对急性心力衰竭患者尿量及电解质的影响。方法将149例急性心力衰竭患者随机分为4组：托拉塞米组（n=32），呋塞米组（n=41），托拉塞米＋螺内酯组（n=30），呋塞米＋螺内酯组（n=46），用药24小时，统计出入量，测定用药前后血钾和血钠浓度，对比分析各组患者尿量及血钠和血钾变化。结果①托拉塞米组和呋塞米组24小时尿量差异无统计学意义，（3591．34±835．15）ml vs（3525．22±842．51）ml（P〉0．05）；②托拉塞米组与呋塞米组对血钠影响差异无统计学意义，（2．24±0．97）mmol／L VS（2．29±1．05）mmol／L（P〉0．05），托拉塞米＋螺内酯组利钠作用最强（3．11±1．72）mmol／L，与托拉塞米组和呋塞米组比较差异均有统计学意义（P〈0．01）；③在排钾作用方面，托拉塞米＋螺内酯组最小（0．09±0．05）mmol／L，而呋塞米组最大（0．25±0．32）mmol／L（P〈O．01），托拉塞米组排钾小于呋塞米组（0．12±0．06）mmol／L（P〈0．01）。结论托拉塞米与呋塞米利尿、排钠作用相近，而托拉塞米排钾作用明显弱于呋塞米，两者交替使用，有助于增加疗效，减少利尿剂抵抗的发生。

Comparison with effects of torasemide and furosemide on urine volume and electrolytes in patients with acute heart failure

Objective To observe effects of torasemide and furosemide on the urine volume and electrolytes in the patients with acute heart failure. Methods Total 149 patients with acute heart failure were randomly divided into four groups:torasemide group(n = 32),furosemide group(n = 41), torasemide add spironolactone group(n = 30) and fruosemide add spironolactone group(n =46). 24 hours after the drugs were used,the urine volume was recorded,and the serum natrium and potassium were detected. The changes of the items were analyzed. Results ① There was no significant difference in the urine volume of 24 hours between torasemide group and furosemide group, (3 591.34±835. t5) ml vs (3 525.22±842. 51) ml(P＞0.05).②In the effect of discharging natrium ion side, there was no significant discrepancy between torasemide group and furosemide group, (2.24±0. 97) mmol/L vs (2.29±1.05)mmol/L(P＞ 0.05). Torasemide add spironolactone group was the most powerful in four groups (3.11±1.72)mmol/L(P＜0. 01). ③In the effect of discharging potassium ion side, which was the most weak in torasemide add spironolactone group (0. 09±0. 05) mmol/L,and strongest in furosemide group(0. 25±0.32) mmol/L (P＜0.01).The torasemide group was inferior to furosemide group in effect of discarging potassium (0. 12±0.06) mmol/L vs (0.25± 0. 32) mmol/L(P＜0.01). Conclusion It is similar between torsaemide and furosemide in the effect of diuresis and discharging natrium. The effect of torasemide keeping potassium is stronger than that of furosemide.Torsaemide and furosemide in alternate use,is helpful to increase therapeutic effect and decrease diuretic resistance.