Senior Director and Head, Department of Gastroenterology, Hepatology and Endoscopy, Max Superspeciality Hospital, Delhi, India, Corresponding Author.
Consultant Physician and Diabetologist, Department of Medicine, Shilpa Medical Research Centre, Mumbai, Maharashtra, India.
J Assoc Physicians India. 2024 Sep;72(9S):32-34. doi: 10.59556/japi.72.0675.
Hepatic edema is caused by decreased hepatic protein synthesis, a consequence of decompensated liver cirrhosis. Fluid accumulation occurs when there is an increase in hydrostatic pressure in the hepatic sinusoids and splanchnic capillaries, as well as low albumin. The first-line treatment for cirrhosis-related ascites is an aldosterone antagonist (spironolactone); however, in severe and recurring ascites, a combination of aldosterone antagonists and loop diuretics (torsemide, furosemide, and bumetanide) is preferable. Torsemide outperformed furosemide in terms of natriuretic and diuretic effects at an equivalent dose. Pharmacological features of torsemide, such as lesser hypokalemia effect, longer duration of action, higher bioavailability, and extended half-life, make it a better alternative than furosemide. In clinical studies, it is considered a safer and more acceptable choice with fewer complications.
肝性水肿是由肝蛋白合成减少引起的，这是失代偿性肝硬化的结果。当肝窦和内脏毛细血管的静水压力增加以及白蛋白水平降低时，就会发生液体积聚。与肝硬化相关的腹水的一线治疗方法是醛固酮拮抗剂（螺内酯）；然而，在严重且反复发生的腹水的情况下，醛固酮拮抗剂和袢利尿剂（托塞米、呋塞米和布美他尼）的联合使用更为可取。托塞米在等效剂量下具有比呋塞米更强的利钠和利尿作用。托塞米的药理学特性，如低钾血症作用较小、作用持续时间较长、生物利用度更高和半衰期延长，使其成为比呋塞米更好的选择。在临床研究中，它被认为是一种更安全、更可接受的选择，并发症更少。
