托拉塞米注射液治疗水肿性疾病安全性和利尿效果研究

目的观察托拉塞米注射液在水肿性疾病中的利尿效果及安全性。方法采用随机、单盲、多中心对照研究方法。托拉塞米注射液与呋塞米注射液的用药剂量比为1∶2。结果共观察了219例肾病水肿、充血性心力衰竭和肝硬化腹水患者,其中托拉塞米组110例,呋塞米组109例。治疗前托拉塞米组和呋塞米组尿量分别为(1300郾09±509郾33)和(1472郾95±647郾88)ml/24h(P=0.03),用药后第1天尿量即分别增至(2091.96±859.76)和(2058.26±828.81)ml/24h(与用药前比较,均P<0.01)。托拉塞米组用药后尿量增加<30%11例,30%～50%24例,51%～80%29例,81%～100%7例,>100%39例;呋塞米组用药后尿量增加<30%31例,30%～50%35例,51%～80%14例,81%～100%12例,>100%27例。托拉塞米组有例在用药后发生一过性耳聋,自行缓1解,以后随访也无听力障碍;其余不良反应与呋塞米组均无差异。结论短期应用托拉塞米注射液治疗水肿性疾病利尿效果显著,副作用小,与呋塞米注射液无显著差异。     

肾移植术中呋塞米不同给药时机对早期尿量及肾功能恢复的影响

目的 比较肾移植术中呋塞米的不同给药时机对早期尿量及肾功能恢复的影响.方法 分析2017年1月至2020年1月在昆明市第一人民医院行同种异体肾移植术的患者100例,采用随机数字表法分为两组,F1组(肾动脉开放即刻静脉注射呋塞米100 mg)和F2组(肾动脉开放前10 min静脉注射呋塞米100 mg).观察两组患者术中...     

袢利尿剂对终末期肾病无尿患者容量控制的疗效观察

目的为探讨袢利尿剂对终末期肾病(ESRD)维持性血液透析(MHD)无尿患者减轻容量负荷的效果。方法2016年9月至2018年8月福建省龙岩人民医院92例尿量在50~100 mL的MHD患者分成三组,对照组A(25例,不用利尿剂),实验组B(34例,使用呋塞米片60 mg/d),实验组C(33例,使用呋塞米片120 mg/d)。研究开始前三组患者基本情况:原发病、年龄、平均尿量、血压、心胸比、血浆脑型钠利尿肽(BNP)、血尿酸值等差异无统计学意义(P>0.05),平均透析间期和透析时间差异无统计学意义(P>0.05),治疗肾性贫血及骨病、高血压、控制饮食及水钠摄入等措施三组相同,观察治疗期为3个月,终点事件为死亡及尿量持续>500 mL/d×14 d,比较三组平均尿量、平均透析超滤量、血压控制情况、心胸比、BNP、血清尿酸等指标。结果无尿患者顽固性高血压患病率54.4%高于有尿患者27.5%(P<0.001)。120 mg/d呋塞米对无尿患者4周内的降压、12周内的利尿效果明显(P<0.05),但4周后降压、12周后利尿效果较差(P>0.05);60 mg/d呋塞米对无尿患者仅1周内的降压、8周内的利尿效果明显(P<0.05),其余时间效果较差(P>0.05)。使用呋塞米对无尿患者减低BNP有统计学意义(P<0.05),此结果独立于尿量的增加。120 mg/d呋塞米能降低心胸比例(P<0.05),但60 mg/d呋塞米则无效(P>0.05)。B组治疗后尿酸改变不明显(K=0.080,P>0.05),而C组治疗后血清尿酸有升高(K=2.739,P<0.05)。结论使用呋塞米对ESRD无尿患者能明显减轻容量负荷并因此减少心胸比、BNP等心衰指标数值,并随着剂量的增加能延长作用时间及效果。     

去甲肾上腺素对肾移植术患者肾功能的影响

目的 探讨去甲肾上腺素对肾移植术患者肾功能的影响.方法 同种异体肾移植术患者32例,ASA分级Ⅲ或Ⅳ级,年龄22～64岁,随机分为多巴胺组(D组)和去甲肾上腺素组(N组),每组16例.麻醉诱导后D组静脉输注多巴胺1～10μg·kg-1·min-1,N组静脉输注去甲肾上腺素0.03～0.3μg·kg-1·min-1,持续至术毕,维持术中MAP波动幅度不超过基础水平的10%.分别于术毕及术后12 h时取中心静脉血样及尿样,测定血清半胱氨酸蛋白酶抑制因子C(Cystatin C)、β2-微球蛋白(β2-MG)及尿α1-微球蛋白(α1-MG)、β2-MG的浓度,并记录术中输液总量、肾血管开放至术毕时的尿量、术后12 h内的尿量及呋塞米的用量.结果 两组术中输液总量、尿量及呋塞米用量和各时点血清Cystatin C、β2-MG及尿α1-MG、β2-MG浓度比较差异无统计学意义(P＞0.05);与术毕时比较,术后12 h时两组患者血清Cystatin C、β2-MG及尿α1-MG、β2-MG浓度均降低(P＜0.05).结论 静脉输注去甲肾上腺素0.03～0.3μg·kg-1·min-1对移植肾功能无不良影响,可用于肾移植术患者.     

前列腺素E1与多巴胺对肝移植术患者术中肾功能的影响

目的 比较体外静脉-静脉转流下原位肝移植术(OLT)中持续输注前列腺素E1(PGE1)和多巴胺对肾功能的影响。方法 拟行OLT的患者18例,ASAⅢ-Ⅳ级,随机分为二组:前列腺素E1组(P组)和多巴胺组(D组),每组9例。P组和D组于麻醉诱导后分别静脉输注前列腺素E1(0.4-0.8μg·kg-1·h-1)和多巴胺(1-3μg·kg-1·min-1)至术毕。无肝期使用体外静脉-静脉转流。放置Swan-Ganz导管连续监测心输出量(CO)及平均动脉压(MAP)。分别于麻醉前(T1)、无肝前期120min(T2)、无肝期40min(T3)、新肝期60min(T4)及术毕(T5)记录MAP,抽取静脉血并留取尿液,测定血清和尿液β2-微球蛋白(β2-MG)以及血清肌酐(Cr),记录术中总尿量、无肝期尿量及呋塞米用量,计算肌酐清除率(CCr)。结果 与T1相比,P组术中各时点MAP、C-Cr和Cr差异无显著性(P>0.05),T5时血清β2-MG降低,T3-5时尿液β2-MG升高(P<0.05);D组术中各时点CCr和MAP差异无显著性(P>0.05),T2-3时Cr降低,T2-5时血清β2-MG显著性降低,尿液β2-MG升高(P<0.01或0.05)。两组MAP、Cr、CCr、血清β2-MG及尿液β2-MG差异均无显著性(P>0.05)。与P组比较,D组术中总尿量及无肝期尿量增多,术中呋塞米用量减少(P<0.05)。结论 肝移植患者术中持续输注PGE1和多巴胺可在一定程度上扩张肾血管、提高肾小球滤过     

托拉塞米治疗颅脑创伤后脑水肿的临床研究

目的:观察托拉塞米治疗颅脑创伤后脑水肿的疗效.方法:将186例颅脑创伤患者随机分为两组,对照组93例给予呋塞米治疗,治疗组93例给予托拉塞米治疗,两组均联合甘露醇125ml静点,q6h,第8天开始依据病情变化调整剂量,两组疗程均为14天,重症者给予心电监护、吸氧等,同时给予常规营养支持及对症治疗,记录每小时及24小时尿量.并通过监测颅内压、电解质水平,观察用药前后颅内压的变化、观察用药前后尿量变化、不良反应发生率.结果:颅内压(ICP)较用药前增高部分(正常高限18.0cmH2O)下降75％以上,治疗组疗效优于对照组(P＜0.05);治疗组尿量明显多于对照组(P＜0.01),并发肾功能不全等比对照组显著减少,电解质紊乱发生率低于对照组(P＜0.05).结论:托拉塞米治疗颅脑损伤,协同应用甘露醇可迅速降低颅内压,控制脑水肿,促进神经功能的恢复,且不良反应少.     

移植肾功能超长时间延迟恢复一例

移植肾功能延迟恢复 (ＤＧＦ)的问题已引起移植界的高度重视。本文报告 1例肾功能恢复延迟达 10 7ｄ者。患者 ,男 ,2 0岁 ,因慢性肾炎尿毒症接受同种尸体肾移植术。供肾移植于右下腹 ,供肾动、静脉与受者的髂内动脉和髂外静脉吻合 ,手术历时 2ｈ。供肾热缺血时间 8ｍｉｎ ,总缺血时间 2 0ｈ。术中无低血压发生 ,血流恢复后 ,移植肾色泽良好 ,质地稍软 ,3ｍｉｎ开始泌尿 ,但尿量较同一对供肾的另一只肾少。术后第 1个2 4ｈ尿量为 14 0 0ｍｌ,后尿量缓慢减少 ,最后每日尿量仅 15 0ｍｌ,与移植前无异。术后第 3ｄ开始给予环孢素Ａ(ＣｓＡ)、泼…     

呋塞米与多巴胺联合应用对肝移植术无肝期肾功能及尿量的影响

目的比较背驮式原位肝移植术中持续输注小剂量多巴胺或呋塞米和多巴胺联合应用对无肝期肾功能和尿量的影响。方法背驮式原位肝移植术患者42例,ASAⅢ~Ⅳ级,随机分为多巴胺组(D组)和呋塞米-多巴胺组(F组),每组21例。两组均于麻醉诱导后静脉泵注多巴胺(2~5μg.kg-1.min-1)至术毕,F组则在无肝期开始时静注呋塞米0.1mg/kg。观察无肝期输液量、血液动力学和尿量,检测血清肌酐(Cr)和肌酐清除率(CCr)。结果与D组比较,F组无肝期尿量明显增多(P<0.05);两组无肝期时间、输液量和心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、每搏量(SV)、心输出量(CO)、全身血管阻力(TSVR)、Cr、CCr差异无显著意义。结论肝移植术中持续泵注多巴胺和呋塞米联合应用可明显增加无肝期尿量。     

呋塞米联合前列腺素E_1微量泵注治疗急性肾衰竭

目的探讨ICU危重病患者并发急性肾衰竭(ARF)早期非透析治疗的方法。方法随机将32例ARF少尿期患者均分为治疗组和对照组,均使用大剂量呋塞米5~10mg·kg-1.d-1。治疗组用呋塞米联合前列腺素E1(PGE1)40μg/d泵注24h;对照组单纯用呋塞米。分别观察并比较两组治疗前6h与治疗后6、12h内的每小时尿量和治疗第1、3天的24h尿量,治疗前和治疗3d后血尿素氮(BUN)及血肌酐(Cr)值及非少尿型肾衰的比率、需要透析的患者比率、肾功能恢复的比率以及死亡率。结果治疗组治疗后12h内每小时尿量和治疗第1、3天的24h尿量明显多于对照组(P<0.05);治疗组治疗后第3天血Cr明显低于对照组(P<0.05),而血BUN两组差异无统计学意义;非少尿型肾衰比率治疗组明显高于对照组(P<0.05),而需要血液透析的患者比率低于对照组(P<0.05);肾功能恢复比率及死亡率两组差异无统计学意义。结论大剂量呋塞米与PGE1联合泵注治疗可以遏止早期ARF的发展。     

应用电子顺磁共振技术研究大鼠肾移植缺血再灌注过程中的NO水平及变化

目的应用电子顺磁共振(EPR)技术动态监测大鼠移植肾缺血再灌注过程中一氧化氮(NO)的产生及其作用. 方法雄性LEW大鼠75只,8～10周龄,体重200～230 g.30只作为供体,供肾0 ℃保存24 h.其余45只分3组,每组15只.第1组为对照组,麻醉后开腹,暴露30 min后关腹;第2组为单纯肾移植组,行同基因肾移植,移植肾再灌注同时切除双肾;第3组为肾移植加N-硝基-L-精氨酸甲脂(L-NAME)组,移植肾再灌注同时切除双肾,供体和受体术前2 h分别给予L-NAME 30 mg/kg.应用EPR动态测定移植肾恢复血流前及之后各时间点NO水平.测定恢复血流后24 h和120 h血肌酐、肾小球滤过率及肾组织羰基含量. 结果单纯肾移植组再灌注后15 min NO开始显著增加并持续上升,120 min达较高水平后迅速下降,到210 min恢复再灌注前水平;肾移植加L-NAME组呈类似变化趋势,但NO水平明显低于前组.L-NAME组的24 h和120 h血肌酐水平均显著高于单纯移植组(P<0.05);24 h(P<0.05)和120 h(P<0.01)肾小球滤过率均显著低于移植组.L-NAME组的24h组织羰基含量显著低于单纯移植组(P<0.05),120 h高于单纯移植组(P<0.05). 结论冷缺血移植肾再灌注过程中,NO早期增加并迅速下降,对移植肾以保护为主.应用L-NAME抑制NO后不利于移植肾功能恢复.     

Torsemide versus furosemide after continuous renal replacement therapy due to acute renal failure in cardiac surgery patients

Diuretic therapy in ARF (acute renal failure) is mainly done with loop diuretics, first of all furosemide. Torsemide has a longer duration of action and does not accumulate in renal failure. In chronic and acute renal failure, both diuretics have been effectively applied, with a more pronounced diuretic effect for torsemide. In this study, the effects of torsemide versus furosemide on renal function in cardiac surgery patients recovering from ARF after continuous renal replacement therapy (CRRT) were studied. Twenty-nine critically ill patients admitted to an intensive care unit at a university teaching hospital after cardiac surgery recovering from ARF after CRRT were included in this prospective, controlled, single-center, open-labeled, randomized clinical trial. Inclusion criteria were urine output >0.5 mL/kg/h over 6 h under CRRT. Torsemide and furosemide dosages were adjusted with the target urine output being 0.8-1.5 mL/kg/h. Hemodynamic data, urine output, volume balance, serum creatinine clearance, electrolytes, blood urea nitrogen, serum creatinine, renin, and aldosterone concentrations were measured. Fourteen patients were included in the furosemide group and 15 patients in the torsemide group. Dosages of 29 (0-160) mg torsemide and a dosage of 60 (0-240) mg furosemide were given every 6 h in each group, respectively. The dosage given at the end of the study decreased significantly in furosemide and torsemide treated patients. Urine output, 24 h balance, and serum creatinine clearance did not differ significantly between groups. Urine output decreased in both groups, mostly dose-dependent in the torsemide group. The intragroup comparison of the first time-interval after inclusion with the last time-interval showed a significant increase in serum creatinine and blood urea nitrogen in the furosemide group. Renin and aldosterone concentrations did not show significant differences. In conclusion, torsemide and furosemide were effective in increasing urine output. Torsemide might show a better dose-dependent diuretic effect in ARF patients after CRRT treatment. Serum creatinine and blood urea nitrogen elimination were less pronounced in the furosemide group.     

血液稀释对全麻腹腔镜活体肾移植供体围手术期氧合功能的影响

目的:探讨不同血液稀释状态对全麻腹腔镜活体肾移植供体围手术期氧合功能的影响。方法:选择健康成年志愿捐肾者48例,随机分为4组:A组(n=10,对照组,乳酸钠林格氏液CIT)、B组(n=12,4~5ml/kg 4%琥珀酰明胶HHD)、C组(n=13,20ml/kg4%琥珀酰明胶HHD),D组(n=13,30ml/kg4%琥珀酰明胶HHD)在全麻腹腔镜下行肾脏摘除术。B、C、D组于麻醉诱导后至肾动脉阻断前分别以4~5ml/kg、20ml/kg和30ml/kg 4%的琥珀酰明胶静脉输注实施不同程度的血液稀释。术中监测麻醉诱导前(T0)、切皮后30min(T1)、肾动脉阻断时(T2)、肾动脉阻断后15min(T3)、手术结束时(T4)及手术结束后240min(T5)的平均动脉压(MAP)、心率(HR)、心电图(ECG)、脉搏血氧饱和度(SpO2)、中心静脉压(CVP)、心输出量(CO)、心脏指数(CI)等。于各时间点抽取动静脉血进行血气分析;T2、T4时分别记录胶体液、晶体液等。手术期间4组以20ml.kg-1.h-1速率常规输注乳酸钠林格氏液。各组手术期间当MAP的变化超过基础值30%时可静脉输注硝酸甘油或多巴胺给予纠正,阻断肾动、静脉后常规应用速尿40mg。结果:(1)4组ECG、SpO2、晶体液总量等均无显著性差异(P>0.05);(2)C、D组T1、T2、T3、T4时MAP、CVP高于A、B组(P<0.05),但均在正常范围内;(3)与T0时相比,C、D组T2、T3时Hb、HcT降低显著(P<0.05),分别达中度(P<0.05)和重度(P<0.01)血液稀释水平;T2、T3时A、D组PaO2下降(P<0.05),而C组升高(P<0.05)。结论:不同血液稀释状态对全麻腹腔镜活体肾移植供体的氧合功能产生不同的影响,在心肺功能良好的供肾者中实施中等度高容量血液稀释是安全的。     

Cardiovascular effects of human atrial natriuretic peptide during renal transplantation

BACKGROUND: We evaluated the cardiovascular effects of human atrial natriuretic peptide (hANP) in the recipients of renal transplantation. METHODS: Anesthesia was maintained by inhalation of nitrous-oxide and isoflurane in oxygen, with epidural block. The recipients were divided into three groups; one group received no hANP infusion as control and the other groups received continuous infusion of hANP at the rate of either 0.05 microg x kg(-1) x min(-1) or 0.1 microg x kg(-1) x min(-1). Intravenous infusion of hANP was started at the anastomosis of renal artery after the fresh frozen plasma was loaded to achieve PCWP over 17 mmHg. In each group, we examined cardiovascular changes by using a pulmonary artery catheter and transesophageal echocardiography. The measurements were done before and after 15 minutes of hANP infusion. RESULTS: In comparison with control, the decreases in PCWP and CVP were significant in the 0.1 microg x kg(-1) x min(-1) group. An increase in CI and the reduction of CVP were significant in 0.05 microg x kg(-1) x min(-1) group, when compared with control group. In the 0.1 microg x kg(-1) x min(-1) group, the reductions of PCWP and CVP and MAP were significant, but the significant increase in CI was characteristic in the 0.05 microg x kg(-1) x min(-1) group. CONCLUSIONS: We conclude that the low-dose infusion of hANP in the recipients of renal transplantation is useful for the optimal anesthetic care because of the cardiovascular improvement.     

门静脉高压犬肝缺血再灌注时肺循环血液动力学及NO/ET和PGI2/TXA2的变化

目的 评价门静脉高压犬肝缺血再灌注时肺循环血液动力学及肺循环一氧化氮(NO)/内皮素(ET)和前列腺素I2(PGI2)/血栓素A2(TXA2)的变化.方法 健康家犬12只,雌雄不拘,体重10～18 kg,随机分为2组(n=6):对照组和模型组.模型组采用部分结扎门静脉的方法 建立犬门静脉高压模型,12周后完全阻断门静脉、肝后下腔静脉30 min,再灌注60 min制备肝缺血再灌注模型.于第2次麻醉后即刻、肝缺血前即刻、缺血5、30 min、再灌注前即刻、再灌注5、10、15、30和60 min(T1-10)时记录心率(HR)、心输出量(CO)、中心静脉压(CVP)、肺动脉楔压(PAWP)和平均肺动脉压(MPAP),计算心脏指数(CI)、肺血管阻力(PVR)和肺血管阻力指数(PVRI),并计算T2-10时CI、CVP、MPAP、PAWP和PVRI相对于T1的变化幅度;于T2、T4和T9时测定肺动脉血浆NO、ET、TXA2和PGI2的浓度,并计算NO/ET和PCI2/TXA2比值.结果 两组肝缺血时CI、CVP、PVRI、PAWP和MPAP均降低,且模型组CI、CVP、PAWP、MPAP降低幅度低于对照组,两组再灌注时CVP、PAWP、MPAP和PVRI均升高,且模型组PAWP和PVRI升高幅度高于对照组(P<0.05或0.01);模型组肝缺血再灌注时肺动脉血浆NO浓度、NO/ET比值和肝缺血时肺动脉血浆TXA2浓度、PGI2/TXA2比值均低于对照组(P<0.01).模型组PVR与肺动脉血浆NO浓度呈负相关(r=-0.567,P<0.05).结论 门静脉高压犬肝缺血再灌注时肺动脉压升高,可能与肺循环NO水平降低、NO与ET失衡有关.     

Effect of N-Acetyl-Cysteine (NAC) Added to Fenoldopam or Dopamine on End-Tidal Carbon Dioxide and Mean Arterial Pressure at Time of Renal Artery Declamping During Cadaveric Kidney Transplantation

N-Acetyl-cysteine (NAC) is known to be a powerful antioxidant used to prevent renal damage. Our deceased-donor kidney transplantation protocol administered an NAC bolus at the time of declamping of the renal artery to reduce the potential oxidative damage with ischemia-reperfusion. The aim of injury this study was to compare the effects of NAC added to a continuous infusion of either fenoldopam or dopamine during kidney recipient anesthesia on mean arterial pressure (MAP) and end-tidal carbon dioxide (ECO₂), which were assumed to be expressions of oxidative and acid-base status. One hundred forty patients undergoing deceased donor kidney transplantation were enrolled in the study. Using a standardized perioperative anesthesia protocol, the patients were divided into 4 groups: group N, receiving an NAC (50 mg/kg) bolus just before renal artery declamping (n = 40); group C, not receiving any NAC or other infusion (n = 20); group NF, same treatment as group N plus fenoldopam (0.1 μg/kg/min) continuous infusion (n = 40); and group ND, same treatment as group N plus dopamine (3 μg/kg/min) continuous infusion (n = 40). We recorded the duration of kidney cold and warm ischemia and EtCO₂ and MAP values before and after arterial declamping, as well as subjective evaluations of graft perfusion and the incidence of early or delayed graft function and adverse events. EtCO₂ was higher and MAP lower in group C compared with group N; comparing groups N, ND, and NF, the NF regimen resulted in lower EtCO₂ and higher MAP values and a greater incidence of early graft function. Subjective evaluation of graft perfusion was more favorable for groups N, ND, and NC, particularly for NF. No significant periprocedural adverse events were recorded in the groups. In our experience, the association of an NAC bolus at the time of renal artery declamping and continuous infusion of fenoldopam resulted in a minor, though non-significant, increase in EtCO₂ values, higher MAP, and greater incidence of early graft function during deceased-donor kidney transplantation compared with no NAC or NAC plus renal-dose dopamine. Further studies are necessary to better define the potential role of oxidative damage in renal ischemia- reperfusion injury, including implications for outcome, as well as the potential role of the combination of NAC plus fenoldopam as a nephroprotective and outcome-modulating regimen.     

控制性低中心静脉压对肝叶切除术患者小肠氧代谢的影响

目的 评价控制性低中心静脉压(CVP)对肝叶切除术患者小肠氧代谢的影响.方法 全麻下择期行肝叶切除术患者30例,ASA Ⅰ或Ⅱ级,随机分为3组(n=10):正常CVP常规输液组(Ⅰ组)、低CVP限制输液组(Ⅱ组)和低CVP常规输液组(Ⅲ组).Ⅰ组及Ⅲ组麻醉诱导前静脉输注乳酸钠林格氏液8～10 ml/kg,麻醉诱导期间开始静脉输注乳酸钠林格氏液和6%羟乙基淀粉130/0.4(1:1)10～15 ml·kg-1h-1.Ⅱ组麻醉诱导前静脉输注乳酸钠林格氏液1 ml/kg,麻醉诱导期间开始静脉输注乳酸钠林格氏液1 ml·kg-1·h-1,至肝实质完全离断前.Ⅱ组和Ⅲ组开腹前静脉注射呋塞咪10 mg,开腹后静脉输注硝酸甘油0.05～0.8μg·kg-1·min-1,在肝实质开始离断前降低CVP至0～5 cm H2O并维持到肝实质完全离断,肝实质完全离断后停用硝酸甘油并快速静脉输注乳酸钠林格氏液和6%羟乙基淀粉130/0.4,使CVP>6 Cm H2O.分别于开腹后降CVP前(T1)及肝实质完全离断后升高CVP前(T2)取桡动脉血样和肠系膜上静脉血样,进行血气分析,测定乳酸盐浓度,计算动脉血氧含量(CaO2)、静脉血氧含量(CsmvO2)、氧摄取率(ERO2)和肠系膜上静脉-动脉乳酸盐浓度差(Dsmv-aBL).结果 与T1时比较,三组T2时CaO2和CsmvO2均下降(P<0.05),但都在正常范围内,ERO2和Dsmv-aBL差异无统计学意义(P>0.05).三组各时点PaO2、SaO2、CaO2、CsmvO2、ERO2和Dsmv-aBL比较差异无统计学意义(P>0.05).结论 控制性低CVP对肝叶切除术患者小肠氧代谢无不良影响,提示机体的氧供需仍能保持平衡.     

帕瑞昔布钠对食管癌根治术患者单肺通气时肺内分流的影响

目的 探讨帕瑞昔布钠对食管癌根治术患者单肺通气(OLV)时肺内分流的影响.方法 择期行食道癌根治术患者45例,年龄47～57岁,体重42～59kg,ASA分级Ⅰ或Ⅱ级,随机分为2组:生理盐水组(C组,n=23)和帕瑞昔布钠组(P组,n=22).P组静脉注射帕瑞昔布钠40 mg(生理盐水稀释至10 ml),C组静脉注射等容量生理盐水.随后两组均靶控输注异丙酚(效应室靶浓度4μg/m1)和舒芬太尼(效应室靶浓度0.3 ng/ml)行麻醉诱导,静脉注射罗库溴铵0.9 mg/kg,光纤支气管镜引导下插入双腔气管导管,行机械通气.于麻醉诱导开始后30 min(T0)、单肺通气15 min(T1)、30 min(T2)、1 h(T3)、恢复双肺通气30 min(T4)和1 h(T5)时测定CVP、HR、MAP和气道平均压(Pmean),同时采集颈内静脉和桡动脉血样,进行血气分析,计算肺内分流率(Qs/Qt).结果 与T0时比较,两组T1-3时Pmean 和Qs/Qt升高(P＜0.05);与T1时比较,两组T2.3.时Qs/Qt降低(P＜0.05);两组各时点Pmean、Qs/Qt、CVP、HR和MAP比较差异无统计学意义(P＞0.05).结论 帕瑞昔布钠40 mg对食管癌根治术患者单肺通气时缺氧性肺血管收缩反应无影响.     

A double-blind randomized crossover trial of two loop diuretics in chronic kidney disease

BACKGROUND: Torsemide has predictable absorption compared to furosemide. Thereby, torsemide results in more constant exposure to active drug. Our hypothesis was that this pharmacokinetic difference between these commonly used loop diuretics may translate into disparate antihypertensive responses in patients with chronic kidney disease (CKD). METHODS: We conducted a randomized, double-blind, two-period, crossover trial to compare the pharmacodynamics of torsemide and furosemide, in 14 subjects with stage 2 or 3 CKD. We first performed an inpatient study, where after the subjects were brought into sodium balance on a 200 mEq per day diet, a single bioequivalent dose of oral loop diuretic was administered with an intervening washout period. Measurements of urinary electrolytes were made. Subjects then participated in an outpatient study, wherein they received daily therapy for 3 weeks with the loop diuretics in random order. Twenty four-hour ambulatory blood pressure monitoring was performed before and after each drug to assess the antihypertensive response. RESULTS: In the inpatient phase, furosemide increased urinary sodium excretion from average (+/-SD) 199 +/- 49 mEq/day to 357 +/- 96 mEq/day and torsemide increased urinary sodium excretion from 213 +/- 79 mEq/day to 398 +/- 142 mEq/day. These differences between the diuretics were not significant, confirming bioequivalence. In the outpatient phase, furosemide reduced 24-hour ambulatory blood pressure from 147 +/- 17/78 +/- 11 mm Hg to 138 +/- 21/74 +/- 12 mm Hg (P = 0.021) and torsemide reduced it from 143 +/- 18/75 +/- 10 mm Hg to 133 +/- 19/71 +/- 10 mm Hg (P = 0.007). Although each diuretic was effective in reducing ambulatory blood pressure, the differences between diuretics were not statistically significant. CONCLUSION: Bioequivalent doses of torsemide and furosemide given in a randomized, double-blind design fail to demonstrate superiority of torsemide with respect to natriuresis or 24-hour ambulatory blood pressure control in subjects with stages 2 and 3 CKD.     

七氟醚与异丙酚对颅内动脉瘤夹闭术患者脑能量代谢影响的比较

目的 比较七氟醚与异丙酚对颅内动脉瘤夹闭术患者脑能量代谢的影响.方法 择期拟行颅内动脉瘤夹闭术的患者68例,ASA分级Ⅱ级或Ⅲ级,年龄22 ～ 62岁,体重52～81 kg,Hunt- Hess 分级Ⅱ或Ⅲ级,采用随机数字表法,将其随机分为2组(n=34):异丙酚组(P组)和七氟醚组(S组).麻醉诱导时P组靶控输注异丙酚,血浆靶控浓度2.0 μg/ml,S组吸入8％七氟醚.麻醉维持时P组靶控输注异丙酚,血浆靶浓度1.5 μg/ml,S组吸入2％七氟醚.于临时阻断前5 min(T0)、临时阻断5 min(T1)、10min(T2)、15 min(T3)、动脉瘤夹闭10 min (T4)、20 min (T5)和40 min (T6)时,收集脑组织微透析液,采用邻苯二甲醛柱前衍生反相高效液相色谱分析法结合荧光法检测微透析液葡萄糖、乳酸和丙酮酸浓度,计算乳酸/丙酮酸比(L/P比).结果 与P组比较,S组T1～ T6时微透析液葡萄糖、乳酸和丙酮酸浓度升高,T2～T4时L/P比降低(P＜0.05).与T0时比较,两组T1～T6时微透析液葡萄糖浓度降低,乳酸浓度升高,T1～T4时丙酮酸浓度降低,T5、T6时丙酮酸浓度升高,T1～T5时L/P比升高(P＜0.05);与T3时比较,两组T～T6时微透析液葡萄糖浓度和丙酮酸浓度升高,L/P比降低,T5、T6时乳酸浓度降低(P＜0.05).结论 七氟醚改善颅内动脉瘤夹闭术患者脑能量代谢的效果优于异丙酚.     

异丙酚对心肌缺血再灌注兔胃粘膜pH值的影响

目的 观察兔心肌缺血再灌注后胃粘膜pH值(pHi)的变化,并探讨异丙酚对心肌缺血再灌注后兔内脏器官微循环灌注的影响。方法20只健康家兔,麻醉后随机分为生理盐水对照组(A组)及异丙酚组(B组,术中5mg·kg-1·h-1)。于基础状态(T0),心肌缺血60min(T1),再灌注后60min(T2)、90min(T3)和180min(T4)分别记录收缩压(SBP)、舒张压(DBP)、心率(HR)和pHi值。结果 两组动物5个不同时点的HR、SBP、DBP无显著差异(P>0.05)。两组动物缺血及再灌注后HR、SBP、DBP均有显著性下降(P<0.01)。pHi变化:与A组相比,B组动物T3点pHi值较低(P<0.05);组内,两组动物缺血及再灌注后pHi值均有显著性下降(P<0.01)。两组动物收缩压(SBP)及HR与pHi的变化均具有显著意义的相关性。结论 兔心肌缺血再灌注后,pHi持续显著降低,且pHi与血流动力学变化趋势一致,具有显著意义相关性。兔缺血再灌注期间,5mg·km-1·h-1异丙酚持续静注并不能改善胃肠道微循环灌注,甚至有可能加重胃肠道的低灌注及氧合障碍。