文章摘要
杨体霞,程昭栋,张军,李峰,王三刚.两种利尿剂不同比例联合应用对慢性心力衰竭患者血钾的影响[J].中国临床保健杂志,2016,(3):287-289.
两种利尿剂不同比例联合应用对慢性心力衰竭患者血钾的影响
Influence of combined applications of diuretics in different dosage ratio on serum potassium level in patients with heart failure
投稿时间:2015-10-10  
DOI:10.3969/J.issn.1672-6790.2016.03.021
中文关键词: 心力衰竭    呋塞米  螺内酯
英文关键词: Heart failure  Potassium  Furosemide  Spironolactone 〖FL
基金项目:
作者单位E-mail
杨体霞 安徽滁州市第一人民医院心血管内科,239000 yangtixia2008@126.com 
程昭栋 安徽滁州市第一人民医院心血管内科,239000  
张军 安徽滁州市第一人民医院心血管内科,239000  
李峰 安徽滁州市第一人民医院心血管内科,239000  
王三刚 安徽滁州市第一人民医院心血管内科,239000  
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中文摘要:
      目的 探讨不同比例保钾利尿剂与排钾利尿剂联合应用对慢性心力衰竭患者血钾的影响。方法 选取住院心力衰竭患者298例,其中包括单纯心力衰竭者179例,心力衰竭合并肾功能不全者119例。单纯心力衰竭组及心力衰竭合并肾功能不全组分别采用随机数字表法分为A、B及C、D四组,均在常规心力衰竭治疗基础上给予排钾利尿剂呋塞米和保钾利尿剂螺内酯联合治疗,A、B、C、D四组呋塞米与螺内酯口服剂量比例分别为1∶1、1∶2、1∶1、1∶2,并排除饮食、基础血钾对血钾的干扰,监测血钾含量及肾功能。结果 A、B、C、D四组低钾血症的发生率分别为66.3%、4.4%、10.2%、0.0%,四组高钾血症的发生率分别为0.0%、1.1%、8.5%、51.7%,四组再入院率分别为9.0%、4.4%、11.9%、13.3%;单纯心力衰竭组中B组较A组低血钾发生率较低,差异有统计学意义(χ2=75.047,P<0.01);心力衰竭合并肾功能不全组C组较D组高血钾发生低,差异有统计学意义(χ2=26.301,P<0.01)。心力衰竭合并肾功能不全组较单纯心力衰竭组患者的总再入院率较高(12.6%比 6.7%),但差异无统计学意义(χ2=3.021,P=0.082)。合并肾功能不全的心力衰竭亚组分析结果显示血钾水平与患者血肌酐水平具有正相关性(Pearson相关系数为0.967,P<0.01)。结论 在正常饮食、肾功能和基础血钾情况下,呋塞米与螺内酯按1∶2联合应用对心力衰竭患者的血钾含量影响较小;而当治疗合并肾功能不全的心力衰竭患者时,应视肾功能不全的轻重调整呋塞米与螺内酯的比例。
英文摘要:
      Objective To explore the serum potassium influence of different dosage ratio of potassium-sparing diuretic and diuretic in heart failure.Method A total of 298 patients with heart failure were collected from our hospital including 179 cases of heart failure and 119 cases of heart failure with renal insufficiency.All subjects were randomly divided into A,B,C and D group,They were received combined treatment of furosemide and spironolactone beside conventional therapy of heart failure.The dosage ratio of furosemide and spironolactone in A,B,C and D group were 1 VS.1,1 VS. 2,1 VS. 1 and 1 VS. 2 respectively.Interruptions on serum potassium were eliminated,including diet,base serum potassium.Results The occurrence rates of hypokalemia in A,B,C and D group were 66.3%,4.4%,10.2% and 0% respectively;and incidence rates of hyperkalemia in A,B,C and D group were 0%,1.1%,8.5% and 51.7% respectively.The readmission rates of four groups were calculated as follows:9.0%,4.4%,11.9% and 13.3%.There were significant difference between B and A group in occurrence rate of hypokalemia in heart failure (χ2=75.047,P<0.01).The incidence rate of hyperkalemia in C group was lower than that in D group with heart failure and renal insufficiency (χ2=26.301,P<0.01).There was no statistical difference in readmission rates between heart failure and heart failure with renal insufficiency(12.6% VS. 6.7%,χ2=3.021,P=0.082).There was a positive correlation between serum potassium and serum creatinine in heart failure with renal insufficiency (Pearson correlation coefficient 0.967,P<0.01).Conclusion Under condition of normal diet,renal function and base serum potassium,the influence of furosemide to spironolactone at 1 VS. 2 on serum potassium is smaller.The ratio of furosemide and spironolactone must be adjusted according serum creatinine in patients of heart failure with renal insufficiency.
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