中国血液净化

中国血液净化 ›› 2021, Vol. 20 ›› Issue (01): 1-5.doi: 10.3969/j.issn.1671-4091.2021.01.01

• 临床研究 •    下一篇

袢利尿剂对有残余肾功能的维持性血液透析患者容量负荷影响的初步研究

张周沧1,丁云飞1,杜凯强2,张东亮1,王梅3   

  1. 1北京大学国际医院肾内科部血液净化中心
    2河北省高碑店德仁医院血液净化中心
    3北京大学人民医院肾内科(丁云飞和张周沧为共同第一作者)

  • 收稿日期:2020-07-23 修回日期:2020-10-15 出版日期:2021-01-12 发布日期:2021-01-07
  • 通讯作者: 张东亮 zhangdongliang@pkuih.edu.cn E-mail:zhangdongliang@pkuih.edu.cn
  • 基金资助:
    北京大学国际医院院内科研基金(YN2017QN15)

The effect of loop diuretic on fluid load in maintenance hemodialysis patients with residual renal function:a pilot study 

  1. 1Blood Purification Center, Department of Nephrology, Peking University International Hospital, Beijing
    2Blood Purification Center, Derin Hospital, Gaobeidian 074000, China; 3Department of Nephrology, Peking University People’s Hospital, Beijing 100044, , China
  • Received:2020-07-23 Revised:2020-10-15 Online:2021-01-12 Published:2021-01-07
  • Contact: Dong-Liang Zhang E-mail:zhangdongliang@pkuih.edu.cn

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摘要： 【摘要】目的探讨袢利尿剂对有残余肾功能的维持性血液透析(maintenance hemodialysis,MHD)患者容量负荷的影响。方法选择有残余肾功能的MHD 患者进行前瞻性研究，给予呋塞米片，在不使用呋塞米片(F0)、呋塞米片100mg/d 1 月后(F100mg)、和呋塞米片200mg/d 1 月后(F200mg)3 个时点，测量血压，检测24h 尿量(24h urine output，24hUO)、尿电解质和血生化等，应用生物电阻抗测量在F0和F200mg2 个时点测定人体成分，包括多余水分(overhydration，OH)和细胞外液(extracellular water，ECW)。重复测量方
差分析不同时点测量指标的变化趋势，简单效应比较不同时点测量指标的差异。结果不同时点之间的居家收缩压和居家舒张压均有显著差异(F 值分别3.239,4.228；P 值分别为0.048，0.020)。随呋塞米片剂量增加24hUO 显著增加(F=4.395，P=0.030)，F200mg时OH 显著低于F0时OH 值(t=-4.321，P=0.049)，F200mg时ECW 显著低于F0时ECW 值(t=-6.912,P=0.015)。结论在有残余肾功能的MHD 患者中使用呋塞米片能增加尿量，改善容量负荷，降低血压。

关键词: 袢利尿剂, 残余肾功能, 维持性血液透析, 尿量, 容量负荷

Abstract: 【Abstract】Objective To explore the effect of loop diuretic on the fluid load of maintenance hemodialysis (MHD) patients with residual renal function. Methods Twenty- five MHD patients with residual renal function were enrolled and given the titration dose of furosemide tablets. 24-hour urine output(24hUO), urine electrolytes, blood biochemical tests and home blood pressure were measured at three time points: before the use of furosemide tablets (furosemide 0, F0), 1 month after 100mg treatment (furosemide 100mg, F100mg) and 1 month after 200mg treatment (furosemide 200mg, F200mg). Bioimpedance analysis (BIA) is used to measure body composition at two time points (F0 and F200mg), including overhydration (OH) and extracellular water
(ECW). Results There were significant differences in home systolic blood pressure [F0: 151.6±17.9, F100mg: 150.8±18.5, F200mg: (146.5±12.3)mmHg, P=0.048] and home diastolic blood pressure [F0: 84.4±8.1, F100mg: 81.9±6.4, F200mg: (81.6± 7.4)mmHg, P=0.020] among three time points. There were significant differences in 24hUO [F0: 626±567, F100mg:689±577, F200mg:759±699ml, P=0.030] between three time points, which showed an increasing trend of urine volume. There were significant differences in both OH [2.47±1.34 vs. (2.15±1.36L), P=0.049] and ECW [16.62±2.67 vs. (16.10±2.89)L, P=0.015] between the two time points of F0 and F200mg. Conclusion The use of furosemide tablets in MHD patients with residual renal function can increase urine volume and improve fluid load and blood pressure.

Key words: Loop diuretic, Residual renal function, Maintenance hemodialysis, Urine volume, Fluid load

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