大剂量速尿持续静脉输入治疗高龄严重心力衰竭患者的研究  

Study of high-dose,continuous intravenous infusion of furosemide as a therapy for elderly patients with severe heart failure

作　　者：唐祖胜[1] 潘庆敏[1] 刘伟[1] 

机构地区：[1]湖北医药学院附属太和医院,湖北十堰442000

出　　处：《现代中西医结合杂志》2011年第31期3917-3918,3920,共3页Modern Journal of Integrated Traditional Chinese and Western Medicine

摘　　要：目的探讨大剂量速尿持续静脉输入治疗高龄严重心力衰竭(心衰)患者的有效性及安全性。方法将确诊为严重心衰的60例高龄患者随机分为治疗组及对照组,2组均予以ACEI(或ARB)、地高辛、硝酸酯类等药物治疗,在此基础上,对照组口服或间断静脉使用速尿(40～80 mg/d),治疗组持续24 h静脉泵入速尿(160～300 mg/d)。治疗5 d后观察2组患者心衰症状的改善情况,记录2组患者再次因心衰而入院的时间间隔,并观察2组患者尿量、ADL量表(Barthel指数)的变化,以了解其有效性;监测治疗组的肾功能、电解质、尿酸、耳毒性等情况,以了解在高龄患者中此种治疗方法的安全性。结果与对照组相比,治疗组的心衰症状、ADL量表(Barthel指数)有明显改善,尿量明显增多,再次因心衰而入院时间间隔明显延长。在严密监测、及时补充电解质的情况,未发现短期内大剂量速尿持续静脉泵入可导致严重的电解质紊乱,亦未见肾功能恶化、耳毒性的发生,虽然尿酸有所升高,但均未引起痛风的发作。结论短期大剂量速尿持续静脉泵入治疗高龄严重心衰,可有效改善患者心衰症状,使因心衰而再次入院的间隔时间延长,而且较为安全。Objective It is to study the efficacy and safety of high-dose,continuous intravenous infusion of furosemide as a therapy for elderly patients with severe heart failure.Methods 60 elderly patients with severe heart failure were randomly divided into treatment group and control group.All the patients were treated with ACEI（or ARB）,digoxin and nitrates.On this basis,the control group was given furosemide administered intravenously by means of either a bolus（or oral administration） every 12 hours at a regular dose（40-80 mg/d）,and the treatment group was given furosemide by continuous infusion at a high dose（160-300 mg/d）.After 5 days＇ treatment,the improvement of CHF symptoms in both groups were observed,the readmission time for heart failure were recorded,and the changes of urine volume and Barthel index were observed to explore its efficiency,and the renal function,electrolyte,uric acid and ototoxicity of the patients receiving continuous diuretic infusion therapy were determined to explore this therapy＇s safety.Results Compared with the control group,the symptoms,Barthel index and urinary volume of treatment group were improved greatly,furthermore,the readmission time for heart failure in treatment group is longer.High-dose,continuous Ⅳ infusion of furosemide was successful in providing diuresis in 5 days without causing clinical complications or aberrations in electrolyte and renal function.Though the blood uric acid was higher,the gout attack in treatment group was not found.Conclusion High-dose,continuous Ⅳ infusion of furosemide can effectively improve heart failure symptoms and increase readmission time for heart fuilure,it can be used as a therapy for elderly patients with severe heart failure is effective and safe in a short time.

关 键 词：速尿 持续静脉输入 心力衰竭 高龄 

分 类 号：R541.6[医药卫生—心血管疾病]