摘要
目的探讨大剂量呋塞米和小剂量高渗盐溶液治疗难治性心力衰竭的疗效和耐受性.方法共66例难治性心力衰竭患者,均为心功能Ⅳ级（NYHA）,射血分数＜35%,血尿素氮＜9mmol/L,血清肌酐＜178μmol/L,24h尿量≤500ml,合并低钠血症.随机分为两组,治疗组静脉应用呋塞米加高渗盐溶液,对照组静脉应用呋塞米加生理盐水,治疗3～7d.治疗期间监测体重、血压、心率、24h尿量和实验室参数以及治疗前后的脑钠素（BNP）水平.治疗组高盐饮食,对照组低盐饮食,两组均限制水的摄入量＜1000ml/d.结果治疗组每日尿量、血清钠改善均优于对照组,两组比较差异有统计学意义（P＜0.05）,BNP水平在组内及组间比较差异均有统计学意义（P＜0.05）,且治疗组再入院率和病死率比对照组明显减少.结论大剂量呋塞米和小剂量高渗盐溶液治疗难治性心力衰竭能很快达到干体重,明显降低BNP水平,心功能得到迅速改善,明显降低30d内的再住院率和病死率.
Objective To explore the efficacy and tolerability of high- dose furosemide and small -volume hypertonic saline solution（HSS） in the treatment of refractory congestive heart failure （CHF）. Methods A totol of 69 patients with refractory CHF were enrolled,with advanced CHF （NYHA functional class Ⅳ） , an ejection fraction 〈 35%, blood urea nitrogen 〈 9mmol/L,serum creatinine 〈 178μmol/L, a low natriuresis （≤500ml/24h） and hyponatremia. The patients were divided into treatment group and control group. For 3 ～ 7 days,the treatment group received intravenous furosemide plus HSS; the control group was given intravenous furosemide plus normal saline. Body weight, blood pressure, heart rate, the totol daily output of urine and laboratory parameters were checked at entry and during hospitalization. Brain natriuretie peptide （BNP） levels were measured on admission and 7 days after discharge. The treatment group received normosodic diet versus iposodic diet. The fluid intake of 1000ml was given to both groups. Results Significant increase daily diuresis and serum sodium was observed in treatment group, P 〈 0.05. The BNP values showed significant intragroup and intergroup differences, P 〈 0.05. In addition, the treatment group showed significant reduction in readmission rate and fatality rate. Conclusion The high - dose furosemide and small - volume HSS group reached dry weight more rapidly, significantly faster reduction in BNP levels and improvement in advanced CHF patients, lower incidence in readmissions and fatality rate in the 30 -day study period.
出处
《中原医刊》
2006年第11期24-26,共3页
Central Plains Medical Journal
关键词
呋塞米
高渗盐溶液
难治性心力衰竭
Furosemide
Hypertonic saline solution
Refractory congestive heart failure
