高渗盐水合并大剂量呋噻米治疗老年难治性心力衰竭疗效的观察

High-dose furosemide and hypertonic saline solution infusion for treatment of senile patients with refractory congestive heart failure

目的观察高渗盐水(hypertonic saline solution,HSS)合并大剂量呋噻米治疗老年难治性慢性心力衰竭的短期疗效并探讨其作用机制。方法符合入选条件的老年心力衰竭患者87例,随机(单盲)分为两组。治疗组(Ⅰ组)47例在常规口服血管紧张素转换酶(ACE)抑制剂、洋地黄、β受体阻滞剂等治疗的基础上加用HSS并大剂量呋噻米静脉滴注30 min,对照组(Ⅱ组)40例在常规口服ACE抑制剂、洋地黄、β受体阻滞剂等治疗的基础上只静脉应用大剂量呋噻米。Ⅰ组患者每天钠摄入量120 mmol,Ⅱ组患者每天80 mmol,两组每天液体摄入量均为1 000 ml,观察两组患者临床疗效及短期随访效果。结果所有患者临床症状均有所改变;两组患者每天尿量及尿钠均明显增加,Ⅰ组更明显(P<0.05);Ⅰ组患者血钠增高,而Ⅱ组患者血钠降低(P<0.05),出院时Ⅰ组患者血钠明显高于Ⅱ组患者(P<0.05);两组患者血钾均降低(P<0.05);体重均减少(P<0.05),Ⅰ组更明显(P<0.05);Ⅰ组患者住院时间及再住院率明显降低(P<0.05);而两组患者左心室射血分数无明显增加(P>0.05)。结论HSS合并大剂量呋噻米治疗老年难治性慢性心力衰竭安全,可靠,耐受性好,短期疗效明显,副作用少。

objective To evaluate the short-term efficacy of small-volume hypertonic saline（HSS） and highdose furosemide infusion in the treatment of senile patients with refractory congestive heart failure（CHF） and the mechanism. Methods A total of 87 senile patients with refractory CHF were enrolled. They were divided （single-blind） into two groups：group Ⅰ（47 patients） received an intravenous drip of furosemide plus HSS, group Ⅱ （40 patients） received an intravenous bolus of furosemide alone. Group Ⅰ received 120 mmol of Na intake daily, while group Ⅱ received 80 mmol. Fluid intake of 1 000 ml was given to both groups. Results The two groups were similar in clinical characteristics（ P 〉 0.05）. All patients showed clinical improvement. Significant increase in daily urine excretion and natriuresis was observed in both groups（ P 〈 0.05）,but they were more significant in group Ⅰ （ P 〈 0.05）. The serum Na level increased in group Ⅰ and decreased in groups Ⅱ（ P 〈 0.05）. The serum K level was decreased in both groups （ P 〈 0.05）. BW was reduced in both groups （ P 〈 0.05）, but it was more significant in group Ⅰ （ P 〈 0.05）. Group Ⅰ showed a significant reduction in length of hospital stay and readmission rate（ P 〈 0.05）. Both groups did not show significant EF improvement. Conclusion High-dose furosemide and small-volume HSS infusion are short-term effective therapy for senile patients with refractory CHF. It is safe, tolerable and has little side effects.