临床上,常会遇到用药矛盾或似乎矛盾的问题,对这些问题缺乏正确认识往往造成处方犹豫甚至治疗失误。清理这些“矛盾”并寻求合理的解决办法实有必要。为此,仅就临床体会参照有关文献作如下探讨。一、同一药物在“矛盾”情况下的应用 1.双氢克尿塞:一般用于利尿消肿,也用于尿崩症及非特异性多饮多尿症(如小儿夏季热)。这主要是利用其药理作用的两个方面。一方面本药抑制肾小管对钠、氯的重吸收而产生盐利尿作用;另一方面由于排钠降低血浆晶体渗透压,从而减轻对口渴中枢的刺激,饮水减少继发尿量减少。因此,除了选择好用药适应证(如肾性尿崩症)外,为提高疗效还要:用于利尿消肿应适当限制水盐摄入, Clinically, often encounter drug contradictory or contradictory problems, the lack of a correct understanding of these issues often result in prescription hesitation or even treatment errors. It is necessary to clean up these “contradictions” and seek a reasonable solution. To this end, only the clinical experience with reference to the literature for the following discussion. First, the same drug in the “contradictory” case 1. Hydrochlorothiazide: commonly used for diuretic swelling, but also for diabetes insipidus and non-specific polyhydramnios (such as pediatric summer fever). This is mainly to take advantage of two aspects of its pharmacological effects. On the one hand, this drug inhibits renal tubular reabsorption of sodium and chlorine to produce salt diuresis; on the other hand, sodium excretion reduces the plasma osmotic pressure of the plasma and thus reduces the stimulation of the thirst center, reducing the secondary urinary output by drinking water. Therefore, in addition to selecting indications for the use of drugs (such as nephrogenic diabetes insipidus), in order to improve the efficacy but also: for diuretic swelling should be appropriate to limit water and salt intake,