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【摘要】目的 探讨持续静脉滴注呋噻米和静脉注射呋噻米后持续静脉滴注维持对肾病综合征水肿患儿的利尿效果。方法 采取自身对照方法，选择原发肾病综合征患儿20例，应用2种给药方式，观察给予呋噻米后12 h患儿尿量及尿钠、钾、氯、肌酐排泄量的变化，并进行比较。同时观察患儿在治疗过程中有无不良反应。结果 在给予静脉滴注呋噻米后最初6 h，患儿尿量明显增高。静脉注射呋噻米后持续静脉滴注维持的患儿在最初6 h中，其尿量及尿钠、钾、氯的排泄量均比单纯持续静脉滴注呋噻米者增加，但只有尿钠、尿氯增高有显著性（P＜0.05)。治疗过程中，未发现不良反应。结论 持续静脉滴注呋噻米对肾病综合征水肿患儿利尿效果安全、有效，之前给予呋噻米静脉注射可提高利尿效果。
【关键词】 呋噻米；持续静脉滴注；肾病综合征；水肿
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
肾病综合征是儿童常见的慢性疾病,其年发病率为2～4/100 000,患病率为16/100 000［1,2］。它以大量蛋白尿、低蛋白血症、高脂血症和水肿为主要临床特点。多数患儿因浮肿就诊，常表现为皮肤水肿，严重者可出现腹水、胸腔积液，治疗上除使用肾上腺皮质激素外，同时应利尿对症治疗。严重水肿时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质和皮质对Cl-、Na+的重吸收，使小管中Cl-、Na+浓度增高，从而降低肾的稀释和浓缩功能，排出大量近于等渗的尿液，达到利尿目的。本文通过不同方式的呋噻米使用方法，探讨呋噻米对肾病综合征水肿患儿的利尿作用医学全在.线www.med126.com。
