托拉塞米对肾移植术患者的利尿效果

目的 评价托拉塞米对肾移植术患者的利尿效果.方法 择期行肾移植术患者45例,年龄31～64岁,体重49～76 kg,性别不限,随机分为2组:呋塞米组(F组,n=23)和托拉塞米组(T组,n=22).F组于移植肾动脉血流恢复前5 min经右颈内静脉注射呋塞米1.6 mg/kg,T组于移植肾动脉血流恢复前10 min经右颈内静脉注射托拉塞米0.8 mg/kg.于入室后即刻(T0)、移植肾动脉血流恢复前即刻(T1)、血流恢复后5 min(T2)和1 h(T3)时取桡动脉血3 ml行动脉血气分析;于T0、T3、移植肾动脉血流恢复后2 h(T4)和6 h(T5)时取右颈内静脉血3 ml行生化检测;于T4时行尿常规和生化检测;记录移植肾见尿时间(肾血流恢复至输尿管断端有液体滴出或流出);于T3-5时记录尿量;记录移植肾热缺血和冷缺血的时间.结果 2组不同时点动脉血气指标、静脉血生化指标、尿常规及生化指标比较差异无统计学意义(P0.05);2组肾血流开放后移植肾见尿时间、各时点尿量比较差异无统计学意义(P0.05).结论 托拉塞米对移植肾的利尿效应强于呋塞米,对酸碱平衡、电解质代谢及移植肾功能的影响无差别,提示托拉塞米可用于肾移植术患者.

Diuretic effect of torsemide in patients undergoing renal transplantation

Objective To evaluate the diuretic effect of torsemide in patients undergoing renal transplantation. Methods Forty-five patients of beth sexes aged 31-64 yr weighing 49-76 kg undergoing renal transplantation were randomly divided into 2 groups: furosemide group (F, n=23) and torsemide group (T, n= 22). Anesthesia was induced with midazolam, fentanyl, propofol and atracurium and maintained with continuous propofol infusion and intermittent iv boluses of atracurium. The patients were intubated and mechanically ventilated (VT=8ml/kg, RR=12 bpm). Left radial artery and right internal jugular vein were cannulated for BP and CVP monitoring, blood sampling and drug administration. In group F furosemide 1.6 mg/kg was given via CVP line at 5 min before reperfusion of donor kidney while in group T torsemide 0.8 mg/kg was given at 10 min before reperfusion of donor kidney. Blood samples were obtained from A-line before induction of anesthesia (T0, baseline), immediately before (T1) and 5 min(T2),1 h(T3) after reperfusion of artery of donor kidney and from CVP line at T0,T3,and at 2 h (T4) and 6 h (T5)after reperfusion of artery of donor kidney for blood gas analysis and determination of Cr, BUN, Na+, K+ and Cl-. Urine was collected at T4 for routine and chemical examination. Urination starting time and urine output at T3-5 were recorded. Results There were no significant differences in all parameters between the 2 groups. Conclusion Torsemide has stronger diuretic effect than furosemide and can be used in patients undergoing renal transplantation. Their effects on acid-base balance, electrolyte balance and renal function are similar.