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。

Usage of torasemide in perioperative management of severe cardiac bivalvular replacement patients

AIM: To evaluate the utilization of torasemide in the perioperative management of severe car diac bivalvular replacement patients through comparing the diuretic effects between torasemide and furosemide. METHODS: Sixty severe cardiac bivalvular replacement patients were divided equally into two groups randomly. Thirty patients (M6, F24, age (54±s 12) a) in the torasemide group were given torasemide through intravenous injection during perioperative treatment while another thirty patients (M5, F25, age (54±12) a) in the fursemide group were given furosemide under the same way. The contents of potassium, sodium and creatinine in 24 h's urine before and 1, 3, 7, 14 d after the treatment were observed. RESULTS: After operation, the contents of potassium, sodium, and creatinine in the urine were all increased in both groups signifi- cantly in comparing with those before the operation (P < 0.01) . Comparing with furosemide group, the decreased contents of the potassium and sodium in the urine of torasemide group were lesser, while the decreased content of creatinine was more (P < 0.01) . The adverse reaction rates of torasemide and furosemide were 10 % (3/30) and 80 % (24/30) respectively, with significant difference (P<0.01). CONCLUSION: Compared with furosemide, torasemide has the effects of both excreting sodium and preserving potassium, so reduce the occurrence of the adverse reactions, and therefore it is more suitable for the perioperative management of the severe bivalvular replacement patients than furosemide.