中国医药
中國醫藥
중국의약
CHINA MEDICINE
2013年
3期
345-347
,共3页
脑水肿%颅脑损伤%托拉塞米%呋塞米
腦水腫%顱腦損傷%託拉塞米%呋塞米
뇌수종%로뇌손상%탁랍새미%부새미
Cerebral edema%Craniocerebral injury%Torasemide%Furosemide
目的 观察托拉塞米与呋塞米在治疗创伤后重型颅脑损伤后脑水肿的临床疗效及颅内压、电解质变化.方法 将我科2010年9月到2011年9月收住的80例颅脑损伤引起脑水肿患者完全随机分为托拉塞米组和呋塞米组,各40例.在维生素水、电解质及酸碱平衡,清除自由基,脑保护等治疗基础上,托拉塞米组患者给予托拉塞米20 mg加入0.9％氯化钠注射液10 ml静脉推注,呋塞米组患者给予呋塞米20 mg+20％甘露醇125 ml静脉推注.2组均1次/6 h,然后根据病情变化随时调整剂量.疗程均为14 d.观察用药前后颅内压的变化,同时观察尿量增加程度和临床疗效.结果 托拉塞米组总有效率明显高于呋塞米组[92.5％ (37/40)比62.5％ (25/40),P＜0.05].2组治疗第1天始,尿量即开始增加,用药第1～7天,患者尿量均高于用药前,差异有统计学意义(P＜0.05).用药第2～7天,托拉塞米组患者尿量均明显高于呋塞米组[(3489±291) ml比(3389±271) ml,(3716±431)ml比(3509±321) ml,(3869±372)ml比(3609±328)m1,(3815±429)ml比(3689±151)m1,(3792±341)ml比(3709±311) ml,(3787±411)ml比(1699±621)ml,均P＜0.05].用药第1～7天,托拉塞米组患者颅内压均明显低于呋塞米组[(17.9±1.1)mm Hg(1 mmHg=0.133 kPa)比(18.3±1.0) mm Hg,(16.7±0.9)mm Hg比(17.9±0.7) mm Hg,(15.9±0.6) mm Hg比(17.1±0.5)mm Hg,(15.5±0.7) mm Hg比(16.6±1.3) mm Hg,(14.8±0.6) mm Hg比(15.8±0.9) mm Hg,(14.8±0.7) mm Hg比(15.4±1.5) mm Hg,(14.3±0.8) mm Hg比(15.7±0.8)mm Hg,均P＜0.05].托拉塞米组电解质紊乱发生率明显低于呋塞米组[7.5％ (3/40)比20.0％(8/40),P＜0.05].结论 托拉塞米治疗创伤性脑水肿可明显降低颅内压,增加尿量,提高疗效.
目的 觀察託拉塞米與呋塞米在治療創傷後重型顱腦損傷後腦水腫的臨床療效及顱內壓、電解質變化.方法 將我科2010年9月到2011年9月收住的80例顱腦損傷引起腦水腫患者完全隨機分為託拉塞米組和呋塞米組,各40例.在維生素水、電解質及痠堿平衡,清除自由基,腦保護等治療基礎上,託拉塞米組患者給予託拉塞米20 mg加入0.9％氯化鈉註射液10 ml靜脈推註,呋塞米組患者給予呋塞米20 mg+20％甘露醇125 ml靜脈推註.2組均1次/6 h,然後根據病情變化隨時調整劑量.療程均為14 d.觀察用藥前後顱內壓的變化,同時觀察尿量增加程度和臨床療效.結果 託拉塞米組總有效率明顯高于呋塞米組[92.5％ (37/40)比62.5％ (25/40),P＜0.05].2組治療第1天始,尿量即開始增加,用藥第1～7天,患者尿量均高于用藥前,差異有統計學意義(P＜0.05).用藥第2～7天,託拉塞米組患者尿量均明顯高于呋塞米組[(3489±291) ml比(3389±271) ml,(3716±431)ml比(3509±321) ml,(3869±372)ml比(3609±328)m1,(3815±429)ml比(3689±151)m1,(3792±341)ml比(3709±311) ml,(3787±411)ml比(1699±621)ml,均P＜0.05].用藥第1～7天,託拉塞米組患者顱內壓均明顯低于呋塞米組[(17.9±1.1)mm Hg(1 mmHg=0.133 kPa)比(18.3±1.0) mm Hg,(16.7±0.9)mm Hg比(17.9±0.7) mm Hg,(15.9±0.6) mm Hg比(17.1±0.5)mm Hg,(15.5±0.7) mm Hg比(16.6±1.3) mm Hg,(14.8±0.6) mm Hg比(15.8±0.9) mm Hg,(14.8±0.7) mm Hg比(15.4±1.5) mm Hg,(14.3±0.8) mm Hg比(15.7±0.8)mm Hg,均P＜0.05].託拉塞米組電解質紊亂髮生率明顯低于呋塞米組[7.5％ (3/40)比20.0％(8/40),P＜0.05].結論 託拉塞米治療創傷性腦水腫可明顯降低顱內壓,增加尿量,提高療效.
목적 관찰탁랍새미여부새미재치료창상후중형로뇌손상후뇌수종적림상료효급로내압、전해질변화.방법 장아과2010년9월도2011년9월수주적80례로뇌손상인기뇌수종환자완전수궤분위탁랍새미조화부새미조,각40례.재유생소수、전해질급산감평형,청제자유기,뇌보호등치료기출상,탁랍새미조환자급여탁랍새미20 mg가입0.9％록화납주사액10 ml정맥추주,부새미조환자급여부새미20 mg+20％감로순125 ml정맥추주.2조균1차/6 h,연후근거병정변화수시조정제량.료정균위14 d.관찰용약전후로내압적변화,동시관찰뇨량증가정도화림상료효.결과 탁랍새미조총유효솔명현고우부새미조[92.5％ (37/40)비62.5％ (25/40),P＜0.05].2조치료제1천시,뇨량즉개시증가,용약제1～7천,환자뇨량균고우용약전,차이유통계학의의(P＜0.05).용약제2～7천,탁랍새미조환자뇨량균명현고우부새미조[(3489±291) ml비(3389±271) ml,(3716±431)ml비(3509±321) ml,(3869±372)ml비(3609±328)m1,(3815±429)ml비(3689±151)m1,(3792±341)ml비(3709±311) ml,(3787±411)ml비(1699±621)ml,균P＜0.05].용약제1～7천,탁랍새미조환자로내압균명현저우부새미조[(17.9±1.1)mm Hg(1 mmHg=0.133 kPa)비(18.3±1.0) mm Hg,(16.7±0.9)mm Hg비(17.9±0.7) mm Hg,(15.9±0.6) mm Hg비(17.1±0.5)mm Hg,(15.5±0.7) mm Hg비(16.6±1.3) mm Hg,(14.8±0.6) mm Hg비(15.8±0.9) mm Hg,(14.8±0.7) mm Hg비(15.4±1.5) mm Hg,(14.3±0.8) mm Hg비(15.7±0.8)mm Hg,균P＜0.05].탁랍새미조전해질문란발생솔명현저우부새미조[7.5％ (3/40)비20.0％(8/40),P＜0.05].결론 탁랍새미치료창상성뇌수종가명현강저로내압,증가뇨량,제고료효.
Objective To observe the effect of torasemide and fnrosemide on cerebral edema after severe craniocerebral injury and the intracranial pressure,to observe the chang of electrolytes levels.Methods All 80 patients with cerebral edema after severe craniocerebral injury enrolled from September 2010 to September 2011 were collected and divided randomly into torasemide group and furosemide group(40 cases each group).The patients in torasemide group were given 20％ mannitol 125 ml + torasemide injection 20 mg,while the fnrosemide group undertook 20％ mannitol 125 ml + furosemide 20 nmg.The course of treatment was 14 days.The effect and the chang of intracranial pressure,electrolytes were detected.Results The total effective rate of torasemide group was higher than that in furosemide group [92.5％ (37/40) vs 62.5％ (25/40),P ＜ 0.05].From first to seventh day for treatment,the urine volume in torasemide group and fnrosemide group were higher than before treatment(P ＜ 0.05),and the urine volume in torasemide group were higher than those in furosemide group at treatment for two,three,four,five,six and seven days[(3489 ±291)ml vs (3389 ±271) ml,(3716 ±431) ml vs (3509 ±321)ml,(3869 ±372)ml vs (3609 ± 328)ml,(3815 ±429)ml vs (3689 ± 151)ml,(3792 ±341)ml vs (3709 ±311)ml,(3787 ±411)ml vs (1699 ± 621)ml,all P ＜ 0.05].The intracranial pressure in torasemide group were less than those in furosemide group during treatment [(17.9±1.1)mm Hg(1 mm Hg =0.133 kPa)vs (18.3 ±1.0)mm Hg,(16.7 ±0.9)mm Hg vs (17.9± 0.7)mm Hg,(15.9 ±0.6)mm Hg vs (17.1 ±0.5)mm Hg,(15.5 ±0.7)mm Hg vs (16.6 ± 1.3)mm Hg,(14.8 ± 0.6)mm Hg vs (15.8 ±0.9)mm Hg,(14.8 ±0.7)mm Hg vs (14.4 ± 1.5)mm Hg,(14.3 ±0.8)mm Hg vs (15.7 ± 0.8)mm Hg,all P ＜0.05].The incidence of electrolyte disturbances in torasemide group was less than that in furosemide group[20.0％ (8/40)vs 7.5％ (3/40),P ＜0.05].Conclusion Torasemide injection for treatment of traumatic brain edema can reduce intracranial pressnre and increase urine volume.
