目的 探讨布美他尼对比其他利尿剂防治肝胆外科常规手术后胸腔积液的临床疗效及安全性。 方法 将168例肝胆外科常规手术患者随机分为布美他尼组及对照组（其他利尿剂）。布美他尼组予布美他尼注射液治疗，每次1 mg静脉注射，每天1次；对照组予呋塞米注射液20 mg治疗，静脉注射每天1次或呋塞米片40 mg口服每天2次或呋塞米片40 mg口服联合螺内酯片60 mg口服治疗每天2次，两组患者均在术后3 d内给予治疗。比较两组患者的术后胸腔积液发生率、住院时间及药物相关不良反应的发生差异。多因素logistic回归分析影响其术后发生中重度胸腔积液的独立危险因素。 结果 布美他尼组入组患者82例，对照组入组86例。两组患者的一般人口学及临床资料比较，除性别和ALT（P < 0.05）外，其余一般基线资料均差异无统计学意义（P > 0.05）。对照组中重度胸腔积液发生率较布美他尼组更高，分别为9.3%和1.2%；对照组住院时间相对较长［（19.94 ± 0.90） d vs. （17.15 ± 1.06） d］，两组上述指标差异均有统计学意义（均P < 0.05）。布美他尼组和对照组胸腔穿刺抽液例数分别为2例和8例，差异无统计学意义（P > 0.05）。两组药物不良反应主要有低钾血症、低氯血症、低钠血症和低钙血症，布美他尼组和对照组总的药物不良反应发生率分别为35.4%和34.9%，差异无统计学意义（P > 0.05）；多因素回归分析结果显示，乙肝病史、肝硬化及使用布美他尼是预测肝胆外科常规手术是否发生中重度胸腔积液的独立因素（均P < 0.05）。 结论 布美他尼注射液防治肝胆外科常规手术后胸腔积液较其他常规利尿剂更有优势，可能具有临床推广应用价值。

Objective To evaluate the clinical efficacy and safety of bumetanide in comparison with other diuretics for the prevention and management of postoperative pleural effusion in patients undergoing hepatobiliary surgery. Methods A total of 168 patients undergoing routine hepatobiliary surgery were randomly assigned to either the bumetanide group or the control group （other diuretics）. Patients in the bumetanide group received bumetanide injection at a dose of 1 mg intravenously once daily. In contrast， the control group received one of the following treatments： furosemide injection at 20 mg intravenously once daily， furosemide tablets at 40 mg orally twice daily， or a combination of furosemide tablets （40 mg orally twice daily） and spironolactone tablets （60 mg orally twice daily）. All treatments were administered for three days postoperatively. The incidence of postoperative pleural effusion， length of hospital stay， and drug-related adverse reactions were compared between the two groups. Additionally， multivariate logistic regression analysis was conducted to identify independent risk factors for moderate-to-severe pleural effusion after surgery. Results A total of 82 patients were enrolled in the bumetanide group and 86 in the control group. No significant differences were observed in the general demographic and clinical characteristics between the two groups （P > 0.05）， except for sex and ALT levels （P < 0.05）. The incidence of moderate-to-severe pleural effusion was higher in the control group than in the bumetanide group， with rates of 9.3% and 1.2%， respectively （all P < 0.05）. Additionally， the length of hospital stay was significantly longer in the control group （19.94 ± 0.90 days） compared to the bumetanide group （17.15 ± 1.06 days） （all P < 0.05）. Thoracentesis was performed in 2 cases in the bumetanide group and 8 cases in the control group， but this difference was not statistically significant （P > 0.05）. The primary adverse drug reactions in both groups included hypokalemia， hypochloremia， hyponatremia， and hypocalcemia. The overall incidence of adverse drug reactions was 35.4% in the bumetanide group and 34.9% in the control group， showing no significant difference （P > 0.05）. Multivariate regression analysis revealed that a history of hepatitis B， cirrhosis， and the use of bumetanide were independent predictors of moderate-to-severe pleural effusion during routine hepatobiliary surgery （all P < 0.05）. Conclusions Bumetanide demonstrates superior efficacy compared to other conventional diuretics in the prevention and management of postoperative pleural effusion in hepatobiliary surgery， suggesting potential clinical application value.