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目的探讨提升血浆晶体渗透压治疗儿童肾病综合征重度水肿的疗效。方法肾病综合征重度水肿患儿106例,在常规治疗基础上均加用呋塞米静脉注射和口服氢氯噻嗪及安体舒通,不限盐饮食。随机分为两组,分别采用0.9%氯化钠溶液为用药溶媒(A组,60例)和5%葡萄糖液为用药溶媒(C组,46例)。检测治疗前后相关指标变化,比较治疗后水肿消退时间和尿蛋白转阴时间,记录并发症发生情况。结果治疗后第3、7天,A组血、尿渗透压、血钠、血氯及尿量均高于C组(P<0.05或P<0.01);治疗后第10天,A组尿量多于C组(P<0.05)。A组治疗后水肿消退时间及尿蛋白转阴时间均短于C组(P<0.05)。治疗后,A组电解质紊乱5例;C组电解质紊乱16例,且肾功能不全2例,低血容量2例。A组治疗总有效率为96.7%,高于C组的52.2%(P<0.01)。结论肾病综合征患儿无需限制钠盐,补充0.9%氯化钠溶液同时加用利尿剂治疗儿童肾病综合征重度水肿疗效确定,并发症少。
Objective To investigate the therapeutic effect of enhancing plasma osmotic pressure on severe edema in children with nephrotic syndrome. Methods A total of 106 children with severe edema of nephrotic syndrome were treated with intravenous furosemide and oral hydrochlorothiazide and spironolactone on the basis of routine treatment without salt diet. The rats were randomly divided into two groups. 0.9% sodium chloride solution was used as drug delivery vehicle (Group A, 60 cases) and 5% glucose solution (Group C, 46 cases). The changes of related indexes before and after treatment were detected. The edema elimination time and urinary protein conversion time were compared after treatment, and the complication occurred. Results The blood and urine osmotic pressure, blood sodium, blood chlorine and urine volume in group A were higher than those in group C on the 3rd and 7th day after treatment (P <0.05 or P <0.01). On the 10th day after treatment, the urine volume More than C group (P <0.05). A group after treatment edema time and urinary protein conversion time were shorter than the C group (P <0.05). After treatment, group A electrolyte imbalance in 5 cases; group C electrolyte disturbance in 16 cases, and renal insufficiency in 2 cases, 2 cases of hypovolemia. The total effective rate of group A was 96.7%, higher than that of group C 52.2% (P <0.01). Conclusion There is no need to limit the sodium in children with nephrotic syndrome, add 0.9% sodium chloride solution plus diuretics in children with severe edema of nephrotic syndrome to determine the efficacy of fewer complications.