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【摘要】目的 探討持續(xù)靜脈滴注呋噻米和靜脈注射呋噻米后持續(xù)靜脈滴注維持對腎病綜合征水腫患兒的利尿效果。方法 采取自身對照方法，選擇原發(fā)腎病綜合征患兒20例，應(yīng)用2種給藥方式，觀察給予呋噻米后12 h患兒尿量及尿鈉、鉀、氯、肌酐排泄量的變化，并進(jìn)行比較。同時觀察患兒在治療過程中有無不良反應(yīng)。結(jié)果 在給予靜脈滴注呋噻米后最初6 h，患兒尿量明顯增高。靜脈注射呋噻米后持續(xù)靜脈滴注維持的患兒在最初6 h中，其尿量及尿鈉、鉀、氯的排泄量均比單純持續(xù)靜脈滴注呋噻米者增加，但只有尿鈉、尿氯增高有顯著性（P＜0.05)。治療過程中，未發(fā)現(xiàn)不良反應(yīng)。結(jié)論 持續(xù)靜脈滴注呋噻米對腎病綜合征水腫患兒利尿效果安全、有效，之前給予呋噻米靜脈注射可提高利尿效果。
【關(guān)鍵詞】 呋噻米；持續(xù)靜脈滴注；腎病綜合征；水腫
The diuretic effect of different usage of furosemide in syndrome children LIU Ling, ZHANG Dongfeng,WANG Li,et al. Department of Nephrology,The Children’s Hospital of Hebei,Shijazhang 050031,China
【Abstract】Objective To assess the pharmacodymamic effects of continuous versus intravenous injection before continuous furosemide infusion in pediatric patients of nephritic syndrome with edema. Methods We undertook a autocontrol trial in 20 pediatric patients of nephritic syndrome with edema.They were treated in two ways with furosemide. When the furosemide infusion was began,we observed the urinary output,the amounts of urinary Na,K,Cl,Cr excretion for the 12 hours in the pediatric patients. We also observed the reaction during the treatment in the patients. Results The urinary output was significantly improved in the first 6 hours in the test.The urinary output,the amounts of urinary Na,K,Cl excretion for the first 6 hours in the children intravenous injection before continuous furosemide infusion were greater than those in continuous furosemide infusion,but only the urinary output and the amounts of urinary Na,Cl excretion significantly(P<0.05).Comparison of the first 6 hours versus the second 6 hours during the treatment,theurinary output in the two ways had statistically significant difference(P<0.05).No patient in test presented adverse reaction.Conclusion Continuous furosemide infusion is effective and safe in pediatric patients nehrotic syndrome with edema. Intravenous injection before continuous furosemide infusion can improve the pharmacodymamic effects.
【Key words】furosemide; continuous infusion; nephrotic syndrome; edema
腎病綜合征是兒童常見的慢性疾病,其年發(fā)病率為2～4/100 000,患病率為16/100 000［1,2］。它以大量蛋白尿、低蛋白血癥、高脂血癥和水腫為主要臨床特點。多數(shù)患兒因浮腫就診，常表現(xiàn)為皮膚水腫，嚴(yán)重者可出現(xiàn)腹水、胸腔積液，治療上除使用腎上腺皮質(zhì)激素外，同時應(yīng)利尿?qū)ΠY治療。嚴(yán)重水腫時一般使用呋噻米利尿。呋噻米的利尿作用主要是抑制髓袢升支粗段的髓質(zhì)和皮質(zhì)對Cl-、Na+的重吸收，使小管中Cl-、Na+濃度增高，從而降低腎的稀釋和濃縮功能，排出大量近于等滲的尿液，達(dá)到利尿目的。本文通過不同方式的呋噻米使用方法，探討呋噻米對腎病綜合征水腫患兒的利尿作用醫(yī)學(xué)全在.線m.zxtf.net.cn。
