摘要
目的 评价排钾 -保钾结合排酸 -保酸利尿方案对肺源性心脏病的优越性。方法 191例肺源性心脏病例随机分为 A组 (42例 )、B组 (6 3例 )、C组 (86例 )。A组予呋塞米 2 0 mg(或氢氯噻嗪 5 0 mg) ,每日一次 ;B组予呋塞米 2 0 mg(或氢氯噻嗪 5 0 mg)、螺内酯 4 0 mg,每日各一次 ;C组予呋塞米 2 0 mg(或氢氯噻 5 0 mg)、螺内酯 4 0mg、乙酰唑胺 2 5 0 mg,每日各一次。对比三组治疗前后 K+ 、Na+ 、Cl- 、p H值、HCO3- 、SBE、Pa CO2 等指标的变化及肺性脑病的发生情况。结果 治疗 7日后 ,A组 K+、Na+、Cl+均显著降低 (P<0 .0 1) ,p H、HCO- 3、SBE和 Pa CO2 均显著升高 (P<0 .0 1) ;B组 Na+ 、Cl- 均显著降低 (P<0 .0 1) ,p H、HCO3- 、SBE和 Pa CO2 均显著升高 (P<0 .0 1) ,而K+ 变化不显著 (P>0 .0 5 ) ;C组虽 Na+ 仍有显著降低 (P<0 .0 5 ) ,但 K+ 、Cl- 、p H、HCO3- 、SBE、Pa CO2 变化均不显著 (P>0 .0 5 )。C组肺性脑病的发生率 (0 % )比 A组 (9.5 % )、B组 (12 .7% )显著减少 (P<0 .0 5～ 0 .0 1)。结论 排钾-保钾结合排酸 -保酸利尿方案对维持肺心病的电解质和酸碱平衡及预防肺性脑病的发生有明显优越性。
Objective To assess the advantage of expelling potassium-retaining potassium diuretic in combination with expelling acid-retaining acid diuretic for cor pulmonale.Methods One hundred ninety-one patients with cor pulmonale were randomly divided into 3 groups: Group A (n=42) received furosemide with 20mg (or hydrochlorothiazide 50mg) once daily; group B (n=63) received furosemide with 20mg (or hydrochlorothiazide 50mg), spironolactone 40mg once daily, and group C (n=86) received furosemide with 20mg (or hydrochlorothiazide 50mg), spironolactone 40mg, acetazolamide 250mg once daily. Group comparisons were made for the variation of K +, Na +, Cl -, pH, HCO 3 -, SBE and PaCO 2 before and after the treatment, and for the attendance of pulmonary encephalopathy.Results For the group A, the 7-day treatment showed that K +, Na + and Cl - decreased significantly (P<0.01), and pH, HCO 3 - , SBE and PaCO 2 increased significantly (P<0.01). For the group B after the treatment, Na + and Cl - decreased significantly (P<0.01), pH, HCO 3 -, SBE and PaCO 2 increased significantly (P<0.01), and K + did not vary significantly (P>0.05). For the group C, although Na + decreased significantly (P<0.05) after the treatment, the variations of K +, Cl -, pH, HCO 3 -, SBE and PaCO 2 were not significantly different from that before the treatment (P>0.05). The rate of attendance of pulmonary encephalopathy in the group C was significantly lower than that in the group A (P<0.05) or in the group B (P<0.01).Conclusion The scheme of expelling potassium-retaining potassium diuretic in the combination with expelling acid-retaining acid diuretic for cor pulmonale has significant advantage in keeping electrolyte balance and acid-base balance, and in preventing pulmonary encephalopathy.
出处
《临床肺科杂志》
2004年第6期643-645,共3页
Journal of Clinical Pulmonary Medicine
关键词
利尿
肺源性心脏病
电解质平衡
酸碱平衡
肺性脑病
diuresis cor pulmonale electrolyte balance acid-base balance pulmonary encephalopathy
