氢氯噻嗪治疗重症监护病房获得性高钠血症：一项随机对照试验。
Hydrochlorothiazide in intensive care unit-acquired hypernatremia: A randomized controlled trial.
作者信息
van IJzendoorn Marjolein M C O, Buter Hanneke, Kingma W Peter, Koopmans Matty, Navis Gerjan, Boerma E Christiaan
机构信息
Department of Intensive Care, Medical Centre Leeuwarden, PO Box 888, 8901 BK Leeuwarden, the Netherlands; Department of Internal Medicine, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands.
Department of Intensive Care, Medical Centre Leeuwarden, PO Box 888, 8901 BK Leeuwarden, the Netherlands.
出版信息
J Crit Care. 2017 Apr;38:225-230. doi: 10.1016/j.jcrc.2016.11.035. Epub 2016 Dec 2.
PURPOSE
Thiazides are suggested as a treatment for intensive care unit (ICU)-acquired hypernatremia (IAH). The primary aim of the study was reducing serum sodium concentration (sNa) in patients with IAH with hydrochlorothiazide (HCT) in comparison to placebo. Secondary end points were a difference in urine sodium concentration (uNa) and duration of severe IAH.
MATERIALS
A monocentric, double-blind, placebo-controlled trial was conducted in 50 patients with IAH and urine potassium + uNa less than sNa in a spot urine sample. Patients were randomized to HCT 25 mg or placebo 1 qd for maximal 7 days. Patients on renal replacement therapy, on medication inducing diabetes insipidus, or with recent use of diuretics were excluded. IAH was defined as sNa of at least 143 mmol/L.
RESULTS
At baseline, sNa and uNa were comparable between groups. During the study period, sNa decreased significantly with median 4 mmol/L in both groups, with no significant difference between groups (P=.32). Median uNa increased significantly in both groups (46 [16-86] mmol/L in the HCT-group; 20 [10-66]mmol/L in the placebo group), with no difference between groups (P=.34). Median duration of sNa of at least 145 mmol/L was 3 days in both groups (P=.91).
CONCLUSION
HCT 25 mg 1 qd did not significantly affect sNa or uNa in patients with IAH.
目的
噻嗪类药物被推荐用于治疗重症监护病房（ICU）获得性高钠血症（IAH）。本研究的主要目的是比较使用氢氯噻嗪（HCT）与安慰剂治疗IAH患者时降低血清钠浓度（sNa）的效果。次要终点是尿钠浓度（uNa）的差异以及严重IAH的持续时间。
材料
对50例IAH患者进行了一项单中心、双盲、安慰剂对照试验，这些患者的即时尿样中尿钾+尿钠低于血清钠。患者被随机分为接受25mg HCT或每日1次安慰剂治疗，最长治疗7天。排除接受肾脏替代治疗、使用导致尿崩症的药物或近期使用利尿剂的患者。IAH定义为血清钠至少为143mmol/L。
结果
基线时，两组间血清钠和尿钠水平相当。在研究期间，两组血清钠均显著下降，中位数下降4mmol/L，组间无显著差异（P = 0.32）。两组尿钠中位数均显著升高（HCT组为46[16 - 86]mmol/L；安慰剂组为20[10 - 66]mmol/L），组间无差异（P = 0.34）。两组血清钠至少为145mmol/L的中位数持续时间均为3天（P = 0.91）。
结论
每日1次25mg HCT对IAH患者的血清钠或尿钠无显著影响。
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